Sunday, April 05, 2009

Let Americans speak, and they will demand single payer now - Santa Cruz Sentinel

by Claudia Chaufan:

What are we to expect from the last of five White House-sponsored Regional Health Care Forums in Los Angeles on Monday? Moderators will attempt to garner support for a 'public option' that will compete with private plans in a 'highly regulated health care marketplace.'

Is there any reason to hope that this public option will take us from "here" the current mess to "there" eliminating financial barriers to health care universally? Sadly, there is not. And there is not because this public option will operate within the same flawed structure that led us where we are. This structure, unlike publicly financed systems such as single payer, has no capacity to control the escalating costs of health care that are eroding the fiscal and economic health of our state and our nation.

So what does single payer, a publicly financed, privately delivered, system do that a "health care marketplace," with or without a public option, does not?

First, it pools risk, by including everybody into one single "plan" that pays for comprehensive medical care. Risk-pooling is a powerful, well-documented cost-control strategy. It purchases care on behalf of all participants, which gives the system great market leverage. An example of such leverage is the price of Lanzoprasol, a widely used drug to reduce acidity. In Spain it costs $9. In Maryland the cost is $329 for the same dose.

It also cuts administrative waste -- from marketing, underwriting, claims adjusting, shareholders' profits, and CEOs salaries, the life-blood of private health insurance -- that eats up no less than 30 cents of each health care dollar in contrast to 3 to 5 cents in publicly financed systems like Medicare.

Last, it cross-subsidizes, which means that the least costly 80 percent always pays for the care of the most costly 20 percent. Nobody knows who will be on which side at any given moment, but we know that the division between the most and least costly patients gravitates toward those proportions. Cross-subsidizing also eliminates the "special categories" -- the too sick, too old, or too poor -- shunned by private insurers, ultimately financed by taxpayers, whether or not they qualify for those subsidies.

The second thing single payer does is financing health care through cooperative compulsory contributions, which simply means that everybody has to pay. This meets the criterion of "shared responsibility," popular among policy experts these days. Yet because of the cooperative dimension of the obligation to pay, contributions are always a predictable proportion of income, unrelated to health status, which makes them affordable to individuals and families. And by combining public financing with private delivery, cooperative compulsory financing is the "public-private partnership" that gives people meaningful choices, not of undecipherable policies with obscure clauses or restricting "preferred providers" lists, but choices of providers, who have the healthy incentive to compete for clients by providing better services

But the Obama administration insists that Americans prefer a "public option" as part of a "menu" of insurance "choices" Maybe the president has listened to renowned Berkeley professor Jacob Hacker, who has argued for the numerous benefits of a Medicare-like plan -- its low administrative overhead, its great market leverage, and its ability to set high quality standards -- and the convenience of including it in a "menu" of "insurance choices." Maybe he overlooked the obvious fact that Hacker has yet to offer a good reason to favor this "health care-marketplace-with-a-public-option" over single payer aside from a vague "Americans prefer choice," according a poll conducted by Professor Hacker that does not ask participants whether their "love of choice" refers to plans or doctors.

Let us hope that on Monday the honest intention of the Obama administration is to let Americans speak. If so, the president might be able to hear what California Sen. Mark Leno, who recently introduced a single payer bill, the California Universal Health Care Act of 2009, noted was a growing social movement. And he might learn why single payer is not merely the only rational policy option, but also the one Americans prefer.

Claudia Chaufan is an assistant professor of sociology and health policy at the UC San Francisco. She received her doctorate in sociology at the UC Santa Cruz, where until recently she lectured.

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