To the Editor:
An ad in the June 8, 2021, Post-Standard by Realities of Single Payer (RSP) included many inaccuracies and false assumptions. RSP is comprised predominantly of insurance companies which have an obvious and vested interest in preserving the health insurance model. As an advocate for equitable, cost-effective and patient-centered health care, I would like to address the major themes articulated in the ad.
95% of NY residents have coverage: Almost half of New Yorkers who have coverage are covered under government plans. Even for the 5% who do not have insurance, health care is paid for by government. Coverage does not equate to access to health care. Premiums paid by employers and copays paid by patients continue to increase. High-deductible plans actually shift costs to patients. All of this as health insurers report growing profits and health care costs remain among the highest liabilities reported in personal bankruptcies.
Single Payer would destabilize health care: Health insurance destabilizes health care. Health insurers use administrative practices such as prior authorization and extrapolation of reimbursement audit findings which increase costs, delay access to care for patients and waste provider time. A single-payer system would allow providers to operate with one consistent set of rules. It would stabilize the administrative environment, save time and reduce waste.
One size fits all government system: This point presumes that consumers benefit from diversity in health plans. Plans offer essentially the same products and the same coverage, utilize overlapping panels of providers and commonly use the same administrative procedures. There is very little price competition. Most insured patients do not pay their own premiums, employers do. They do not benefit from the little price competition that does exist. In fact, they have limited choices because their employer chooses the health plan. Employers purchase policies with the lowest premium and the highest cost-sharing for the employee. A single-payer system would provide the same covered benefits but use a single set of administrative rules. There would be no confusion or inconsistency regarding participation by providers. All providers would be included.
Eliminate 160,000 jobs: Changes in market dynamics and technological advancement cost the economy thousands of jobs annually. Businesses, including health plans, routinely downsize whenever it benefits them, and no one argues that people who lose their jobs because of market changes, technology or corporate avarice should deserve protection. Executive, administrative and clerical personnel whose jobs would become unnecessary would be absorbed elsewhere in the economy because their skills are easily transferable to other businesses.
Provider funding would be decimated: Plans control payment to providers and do not negotiate payment with individual providers. They impose arbitrary payment schedules which only reflect their interests and ignore provider costs. A single-payer system would empower providers to collectively negotiate for payment which includes consideration of provider costs and consumer needs.
Union members would lose benefits they have obtained through negotiations: Employers would not pay premiums anymore. Unions could bargain for investment of some of these savings in higher compensation, other benefits and improvements in working conditions. Actual elements of union negotiated plans are unlikely to change at all. Covered benefits would be comprehensive and there would be no patient cost-sharing. Benefits obtained through union negotiation would not be diminished.
The final paragraph of the ad says, “Targeted measures can be adopted which both make coverage more affordable and attain universal coverage.” This is a concession that the cost of the current system is a burden for consumers and that we have failed to reach universal coverage.
A single-payer system presents the greatest potential for patient-centered reform of our health care system. Health is a basic human right. We deserve a health care system which provides affordable, quality health care for everyone.
The insurance model has failed. The proof is evident in higher premiums, higher costs for patients, and barriers to continuity and preventive care. It yields an irrational reliance on expensive hospital and emergency-based care by uninsured patients, often for preventable diseases. The current insurance model creates inequities in access to care. The frustration of dealing with administrative minutia and myriad rules by multiple plans to delay or deny coverage contributes to physician burnout.
A single-payer system founded on the principle that everyone has a right to health care and paid for by public investment would save money, enhance patient centeredness and inject equity into a system that is currently distorted by profit motives.
As Jesse Jackson, Jr. has said: “It’s not logical that we boast the most advanced and powerful internationally integrated economy in the world, then claim organizational incompetence and poverty when it comes to creating and funding a national health care system for all Americans.”
Dr. James Mumford
President
New York State Academy of Family Physicians
Albany