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The Case For Single Payer, Universal Health
Care For The United States
Outline of Talk Given To The Association of
State Green Parties, Moodus, Connecticut on June 4, 1999
By John R. Battista, M.D. and Justine McCabe, Ph.D.
- Why doesn’t the United States have universal health care as a right
of citizenship? The United States is the only industrialized nation that
does not guarantee access to health care as a right of citizenship. 28
industrialized nations have single payer universal health care systems,
while 1 (Germany) has a multipayer universal health care system like
President Clinton proposed for the United States.
- Myth One: The United States has the best health care system in the
world.
- Fact One: The United States ranks 23rd in infant mortality, down
from 12th in 1960 and 21st in 1990
- Fact Two: The United States ranks 20th in life expectancy for
women down from 1st in 1945 and 13th in 1960
- Fact Three: The United States ranks 21st in life expectancy for
men down from 1st in 1945 and 17th in 1960.
- Fact Four: The United States ranks between 50th and 100th in
immunizations depending on the immunization. Overall US is 67th, right
behind Botswana
- Fact Five: Outcome studies on a variety of diseases, such as
coronary artery disease, and renal failure show the United States to rank
below Canada and a wide variety of industrialized nations.
- Conclusion: The United States ranks poorly relative to other
industrialized nations in health care despite having the best trained
health care providers and the best medical infrastructure of any
industrialized nation
- Myth Two: Universal Health Care Would Be Too Expensive
- Fact One: The United States spends at least 40% more per capita on health
care than any other industrialized country with universal health care
- Fact Two: Federal studies by the Congressional Budget Office and the
General Accounting office show that single payer universal health care would
save 100 to 200 Billion dollars per year despite covering all the uninsured
and increasing health care benefits.
- Fact Three: State studies by Massachusetts and Connecticut have shown that
single payer universal health care would save 1 to 2 Billion dollars per year
from the total medical expenses in those states despite covering all the
uninsured and increasing health care benefits
- Fact Four: The costs of health care in Canada as a % of GNP, which were
identical to the United States when Canada changed to a single payer,
universal health care system in 1971, have increased at a rate much lower than
the United States, despite the US economy being much stronger than Canada’s.
- Conclusion: Single payer universal health care costs would be lower than
the current US system due to lower administrative costs. The United States
spends 50 to 100% more on administration than single payer systems. By
lowering these administrative costs the United States would have the ability
to provide universal health care, without managed care, increase benefits and
still save money
- Myth Three: Universal Health Care Would Deprive Citizens of Needed
Services
- Fact One: Studies reveal that citizens in universal health care systems
have more doctor visits and more hospital days than in the US
- Fact Two: Around 30% of Americans have problem accessing health care due to
payment problems or access to care, far more than any other industrialized
country. About 17% of our population is without health insurance. About 75% of
ill uninsured people have trouble accessing/paying for health care.
- Fact Three: Comparisons of Difficulties Accessing Care Are Shown To Be
Greater In The US Than Canada (see graph)
- Fact Four: Access to health care is directly related to income and race in
the United States. As a result the poor and minorities have poorer health than
the wealthy and the whites.
- Fact Five: There would be no lines under a universal health care system in
the United States because we have about a 30% oversupply of medical equipment
and surgeons, whereas demand would increase about 15%
- Conclusion: The US denies access to health care based on the ability to
pay. Under a universal health care system all would access care. There would
be no lines as in other industrialized countries due to the oversupply in our
providers and infrastructure, and the willingness/ability of the United States
to spend more on health care than other industrialized nations.
- Myth Four: Universal Health Care Would Result In Government Control And
Intrusion Into Health Care Resulting In Loss Of Freedom Of Choice
- Fact One: There would be free choice of health care providers under a
single payer universal health care system, unlike our current managed care
system in which people are forced to see providers on the insurer’s panel to
obtain medical benefits
- Fact Two: There would be no management of care under a single payer,
universal health care system unlike the current managed care system which
mandates insurer preapproval for services thus undercutting patient
confidentiality and taking health care decisions away from the health care
provider and consumer
- Fact Three: Although health care providers fees would be set as they are
currently in 90% of cases, providers would have a means of negotiating fees
unlike the current managed care system in which they are set in corporate
board rooms with profits, not patient care, in mind
- Fact Four: Taxes, fees and benefits would be decided by the insurer which
would be under the control of a diverse board representing consumers,
providers, business and government. It would not be a government controlled
system, although the government would have to approve the taxes. The system
would be run by a public trust, not the government.
- Conclusion: Single payer, universal health care administered by a state
public health system would be much more democratic and much less intrusive
than our current system. Consumers and providers would have a voice in
determining benefits, rates and taxes. Problems with free choice,
confidentiality and medical decision making would be resolved
- Myth Five: Universal Health Care Is Socialized Medicine And Would Be
Unacceptable To The Public
- Fact One: Single payer universal health care is not socialized medicine. It
is health care payment system, not a health care delivery system. Health care
providers would be in fee for service practice, and would not be employees of
the government, which would be socialized medicine. Single payer health care
is not socialized medicine, any more than the public funding of education is
socialized education, or the public funding of the defense industry is
socialized defense.
- Fact Two: Repeated national and state polls have shown that between 60 and
75% of Americans would like a publicly financed, universal health care system
- Conclusion: Single payer, universal health care is not socialized medicine
and would be preferred by the majority of the citizens of this country
- Myth Six: The Problems With The US Health Care System Are Being Solved and
Are Best Solved By Private Corporate Managed Care Medicine because they are the
most efficient
- Fact One: Private for profit corporation are the lease efficient deliverer
of health care. They spend between 20 and 30% of premiums on administration
and profits. The public sector is the most efficient. Medicare spends 3% on
administration.
- Fact Two: The same procedure in the same hospital the year after conversion
from not-for profit to for-profit costs in between 20 to 35% more
- Fact Three: Health care costs in the United States grew more in the United
States under managed care in 1990 to 1996 than any other industrialized nation
with single payer universal health care
- Fact Four: The quality of health care in the US has deteriorated under
managed care. Access problems have increased. The number of uninsured has
dramatically increased (increase of 10 million to 43.4 million from 1989 to
1996, increase of 2.4% from 1989 to 1996- 16% in 1996 and increasing each
year).
- Fact Five: The level of satisfaction with the US health care system is the
lowest of any industrialized nation.
- Fact Six: 80% of citizens and 71% of doctors believe that managed care has
caused quality of care to be compromised
- Conclusion: For profit, managed care can not solve the US health care
problems because health care is not a commodity that people shop for, and
quality of care must always be compromised when the motivating factor for
corporations is to save money through denial of care and decreasing provider
costs. In addition managed care has introduced problems of patient
confidentiality and disrupted the continuity of care through having limited
provider networks.
- Overall Answer to the questions Why doesn’t the US have single payer
universal health care when single payer universal health care is the most
efficient, most democratic and most equitable means to deliver health care? Why
does the United States remain wedded to an inefficient, autocratic and immoral
system that makes health care accessible to the wealthy and not the poor when a
vast majority of citizens want it to be a right of citizenship?
Conclusion: Corporations are able to buy politicians through our campaign
finance system and control the media to convince people that corporate health
care is democratic, represents freedom, and is the most efficient system for
delivering health care
- What you can do about this through your state Green Party
- Work to pass a single payer, universal health care bill or referendum in
your state. State level bills and referenda will be most effective because a
federal health care system might in fact be too bureaucratic, and because it
is not politically realistic at this time.
- Bills or referendum must be written by and supported by health care
providers for the legislature to take them seriously. It is thus imperative to
form an alliance with provider groups. The most effective provider group to go
through is Physicians For A National Health Program which has chapters in
every state (see hand out for partial listing of contact people). A number of
states already have organized single payer efforts: Massachusetts, California,
Washington, Oregon, New Mexico, and Maryland. Join with them.
- A first step is to contact state representatives from PNHP and offer to
join with them to write and support a bill bringing single payer, universal
health care to your state if this has not already been done. The Connecticut
and Massachusetts Bills can be used as models to make this task easier (email
us at riverbnd@javanet.com and we will send you copies of the bills). A
referendum is another way to go, in which case the California referendum can
be used as a model.
- A second step is to contact state legislators and find a group who are
willing to sponsor such a bill.
- A third step is to create a coalition of groups to work together to
support and publicize this work, or to try to bring together existing groups
to work together on this project. Labor unions, progressive democratic groups,
Medicare/Senior Advocacy groups, the Labor Party, the Reform Party, UHCAN,
existing health care advocacy groups, and state health care provider groups
are all imporatnt to work with and get to join such a coalition. The state
medical society and state hospital association are critical to work with in
order to get any legislation passed. Try to get them to work with you to
design a new model for health care delivery. They will be particularly
concerned about who will control the system, and be very mistrustful of
government. A public trust model with participation by providers, hospitals,
business, the public and government is like to be much more acceptable to them
than a pure government system. Emphasize doing away with managed care, and get
them to try and work with you to find other ways to control costs (necessary
to convince politicians) such as quality assurance standards, which will also
protect them from malpractice
- A fourth step is to give talks in support of your bill or referendum
where ever possible. Senior groups, medical staffs, church groups, high school
assemblies, and labor unions are particularly good sources. Excellent
materials including slides, a chart book and videos are available through PNHP.
- A fifth step is to raise money through fund raisers, contributions and
benefits held by entertainers. Benefits are particularly useful in bringing
out people who you can inform about single payer, universal health care and
your efforts.
- A sixth step is to develop media access. The creation of videos that can
be shown on local cable access TV stations is very effective. Newspaper
articles, letters to the editor, and articles by the press are critical. Radio
interviews and radio talk shows are important.
- Getting the public to write
and call their state representatives in support of a proposed bill is
critical, as is coordinating testimony at a public hearing.
- Because the data about single payer universal health care are so
revealing of the problems with corporate America, and because the US citizenry
is so concerned and dissatisfied with our health care system these efforts may
yield surprisingly positive results and be helpful in establishing the Green
Party in the US as a party of the people, by the people and for the people.
We would be happy to help you. Contact us by email at riverbnd@javanet.com,
by phone at 860-354-1822, or by mail at 88 Cherniske Road, New Milford, CT
06776
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