Why we need a single-payer system

**Blogger's note: This is a bit less concise and well-organized than most of my posts, I think. This is, at least partially, because I (appropriately enough) have been fighting a cold all week. Makes me less patient about editing and more interested in spewing rants onto the page. Still, I feel strongly about health care. Probably because it consumes so much of my and Tim's life. I hope you'll find some of my points interesting. I hope you'll be polite about the ones you disagree with. Either way, I hope you leave a comment.

Picture by dubble.think

Okay, I know I've groused before about Medicare. It has its problems, to be sure. But, of all the options out there, right now, I firmly believe a single-payer system is the best chance we have.


I will probably get some people who violently disagree with me. Heck, one guy on Twitter blocked me because I disputed that we have "the best health care system in the world."


What was funny about the whole exchange, really, is that I tried to explain to him why his statement was so patently false. My first line of attack was that we have people dying from staph infections. It takes one small antibiotic. Very common, very easy. And yet people wait. Because they can't afford to see a doctor.


He pointed out that any emergency room would have to treat them. (Actually, not true. Any public hospital's emergency room has to take you. But I didn't want to argue semantics.) So I told him that, while that's true, if you wait to go the ER, you have two more problems: the bills are even bigger, and your conditions has worsened considerably.


He didn't reply to that. So I mentioned Tim's $502/month insurance, or 18% of our post-tax income. And that's not even touching on the $500 deductible, the co-pays, etc. At his dermatologist -- the doctor Tim sees the most -- we have already racked up nearly $500 in the past 6 months.


I also mentioned that I'm on Medicare, myself. But he apparently was done with the subject. He told me I didn't know what I was talking about, and he didn't want this stuff on his twitter.


His right to not listen, of course. Still, given that I've traversed the bureaucracy of Medicare, Medicaid, private insurance and hospital financial aid, I find it funny that he could accuse me of ignorance.


So, taking all that into account, I will admit a couple of things: I don't know anything about the budget or about where, exactly, all the money will come from. But I felt the need to blog about this because I do know quite a bit about being broke in America -- just barely getting by or, in some cases, sinking deeper into debt just trying to survive -- while also dealing with health issues.


And all that experience tells me that we need a single-payer system.


Just to be sure we're all on the same page, that means a system similar to Medicare. And just to be sure we're all talking about reality -- not what some talking heads are telling you will happen -- let's review Medicare briefly.

• Part A: Hospital Insurance. This is generally free of charge. (For exceptions, go here.) Part A covers inpatient care, skilled nurse facilities, etc.

• Part B: Health Insurance. The monthly charge is $96.40. People with low income can qualify for help with premiums.
  

• Medicare Advantage Plan. This allows you to buy better health care plans. You have the choice of managed care, PPO or fee-for-service. Depending on the quality of the plan, the price varies. This cost is on top of your Part B premiums.

• Medicare Prescription Plan. This provides more thorough prescription-cost coverage.
  

So, this plan isn't perfect. It needs some tweaking, especially when you start to consider the donut hole. But it's still better than letting 1 of every 6 Americans go uninsured. (And plenty of the other 5 have things like high-deductible insurance, which discourages getting routine care.)


Here are my arguments:

• We would have a lower mortality rate. By the time some people get diagnosed, their diseases are out of control. My mom was on a bus and overheard two fast food employees chatting. One of their coworkers died from MRSA. That's the same thing that Tim's had more than 20 times in the past two years. The only difference: Tim had insurance and a wife who knew how to get financial help for medical bills.
  

• A healthier America. If people got more routine care, we would arguably have a better shot at staying healthy. Obviously, some disabilities cannot be helped. Mine certainly wasn't avoided by having insurance. But many health conditions that keep people from working full-time are also ones that could be avoided -- or at least ameliorated -- by having medical care.

• Less welfare. The better people are, the more likely that they can work and earn a living. I don't care what kind of things you believe about homeless people and people on welfare. Yes, there are some people who are playing the system or otherwise have choices. Most of us don't. Most of us would love nothing more than to be able to work and support ourselves.

• Less money for Medicaid. I actually started paying more out of pocket once I was accepted to Medicare than on Medicaid. The state of Washington gave me no deductibles, no co-pays, no anything. Currently, Medicaid provides low-income folks with coverage, but it also covers premiums and lowers co-pays for low-income Medicare users. Under a single-payer system, the state would no longer have to cover 100% of some residents' care.

• More money for hospitals. Right now, there are tons of hospital bills that won't get paid. Either the patient applies for financial assistance, and most of the charges are waived, or people simply default because the amounts are just too high. With more folks insured, this would reduce the pressure on already limited hospital funds. This would probably mean fewer funds coming from state and federal programs, as well.
  

• Potentially lower medical bills. If hospitals don't have to make up for non-payments, they could probably bill for less. If they know they'll always get at least something for services, actual charges could be less. Probably naive, but at least at community hospitals, they do have an interest in helping everyone. (Of course, I also believe that if we subsidized medical school -- requiring a certain period of work at free clinics in exchange -- we could help lower medical costs. If doctors had less debt to erase, they could afford to charge more reasonable amounts.)

• More reasonable ER wait times. Right now, across the country, ERs are clogged full of patients. It's stressful, noisy and very, very tedious. ERs tend to be uninsured Americans' general practitioner. One friend of mine ended up in the hospital for three days because of a spider bite. It got infected and, by the time he finally saw a doctor, the infection was spreading into his bloodstream. I'm sure a lot of people could have used his bed. And I know he and the hospital would have loved to save the money for something less preventable.
  

• Economic stimulus. If employers no longer shoulder the burden of health care costs, businesses would be hurting a lot less. The average individual plan is close to $500. So even if you pay $200 a month, your company is still paying $300 per employee. Every month. With that money, the business could give raises, hire more people or, at the very least, not fire more people. This could help staunch the rising unemployment rate.
  

Of course, for me, the best argument remains the most human one: Everyone deserves health care. Not last-minute care that threatens your financial future. Not care only once you've put your life in danger by trying to take care of it yourself. We deserve help when we need and preventative care so that, hopefully, we won't.


Yes, a lot of details need to be worked out. The donut hole, for one. Though, of course, if you're not on disability or retirement, the donut hole will be far less financially devastating. And some of the co-pays for in-patient care need to be fine-tuned.


But I'm sick of hearing that we have to keep competition to keep insurance companies competitive. There is competition already, in the market. There are plenty of insurance companies, and health care costs only continue to rise. Meanwhile, the bureaucrats at the companies try to find reasons not to pay out, or ways to kick people off their policies. But because they have so many customers, they can negotiate lower rates. Often, they pay less than 75% of the billed amount. Yet people without coverage, people who really need the help, can only get a few percent off for paying in cash.


In short, this system isn't working. And I'm sick of listening to healthy, middle-class Americans preach that "socialism" isn't the way to go. One out of three American families is already on some form of government help. So clearly capitalism isn't exactly working out that well, either.


How about we try something new? Something that, say, other governments rely on all the time. I'm tired of quibbling about inherent problems. Any idea will have flaws and drawbacks. The point is to find the one that benefits the most people. Install that and then do your best to make it better over time.


And if you disagree, take a notebook and a pen and go spend some time down in an ER. Talk to the people there. But wear a mask. You wouldn't want to get sick, now, would you?