SHOULD WE CONSIDER ADOPTING A SINGLE-PAYER HEALTHCARE SYSTEM?

This is the time of the year when many of us need to consider our health insurance options. Given the steep increases in premiums, this may also be when we re-confront the discussion about what kind of health insurance system our country should ultimately adopt. Since we are in the midst of a poliktical election cycle as well, the pundits argue publicly for and against the Affordable Care  Act (a.k.a. Obamacare), the desirability of adopting a single-payer healthcare system as prevalent in virtually all developed countries, or to stick with the market based private insurance system we supposedly have even under Obamacare.

Single-payer national health insurance, also known as "Medicare for all," is a system in which a single public or quasi public agency organizes healthcare financing, while the delivery of care remains largely in private hands. Under a single-payer system all residents of the U.S. would be covered for all medical necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive healthcare, dental, vision, prescription drug and medical supply costs. In the 1950s U.S. health statistics were world class: Infant mortality among the lowest, life expectancy among the highest, and health care costs about average. One by one other nations - like Denmark, Sweden, Australia, the U.K., Canada and Taiwan - adopted national health programs. By the end of the 20th century the U.S. was the lone holdout for private, for profit health insurance. Its health statistics lagged behind dozens of countries, while costs soared to twice the average in other wealthy nations.

The U.S. spends 16% of GDP on health. This compares to 8.5% in the U.K. and Australia, and significantly less than 16% in most developed countries. Of eleven nations studied by the World Health Organization and the OECD the U.S. ranked lowest on accessibility, efficiency, and healthy lives outcomes (mortality related to medical care, infant mortality, and healthy life expectancy at age 60.) A similar study done by the Commonwealth Fund in 2014 confirmed these conclusions.

Many countries have realized huge savings by evicting private insurers and eliminating the reams of expensive paperwork they require from doctors and hospitals. Aetna keeps 19 cents of every premium dollar for overhead and profit. U.S. hospitals devote 25.3% of total revenue to administration, which reflects the high cost of collecting patient co-payments and deductibles, and fighting with insurers. Obamacare will  direct an additional $850 billion in public funds to private insurers, and boost insurance overhead by $273.6 billion. Yet, it will leave 26 million citizens uninsured, and similar numbers with such skimpy coverage that a major illness will bankrupt them. By contrast, insurance overhead in single-payer systems takes only 1-2 percent. Proponents estimate (and argue) that moving to a single-payer system would save about $400 billion a year on paperwork and administration.

The controversy surrounding the single-payer system does not seem to focus on the desirability of achieving universal coverage, it is largely concerned with the means of getting there. Thus far the arguments have not changed much over time. Proponents suggest that the system provides universal coverage; diminishes the administrative load on healthcare professionals; significantly lowers cost; eliminates the need for insurance companies; and requires only one buyer which would improve efficiency while providing substantial negotiating power.

Those opposed retort that the system would be government controlled, effectively converting everyone in the system to government employees; would diminish the incentive to pursue research and development; force higher taxes with fewer benefits; contribute to drug abuse; and promote a rising demand for welfare.

This conversation ties into the ongoing dispute over raising the Medicare eligibillity age to help pay for the benefits most of us paid for during our working life. The trust funds paying into Social Security and Medicare are estimated to dry up by the early 1930s. One argument being floated is that raising the eligibility age will over time allow us to free up resources that could be used to achieve universal coverage along the lines of Switzerland's market based system (Avik Roy, Forbes, December 12, 2012). While these discussions continue, we might keep an eye on the outcome of a single-payer "ColoradoCare" proposal Colorado is placing on their 2016 ballot, which is designed to replace Obamacare with a new single-payer system (at a cost of $25 billion per year.)

Fareek Zakaria, a political centrist, journalist and author with a regular program on CNN, answers our opening question as follows: "There is absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provisions,  a single government payer and multiple private providers is the answer."

While we may be tempted to add our two cents to the discussion, real change will require political courage, which Washington appears to be lacking. It is easier to express contempt for Obamacare than it is to come up with an alternative. In the mean time we just need to suck it up and pay the premiums, unless we are lucky and old enough to go on Medicare.