On the value of a single payer healthcare program, again

An opinion published by Bloomberg News and reproduced in the Gazette Times ( April 11, 2024) suggested that, as a way to control healthcare costs and broaden access to affordable choices, lawmakers should reconsider introducing a public option – a government-run plan that would compete alongside private insurance companies. It cited efforts from states like Colorado and Washington that used legislative tools like premium-reduction targets, or price negotiations for reimbursement rates for hospitals and clinical providers, and concluded that it is “perhaps the most promising way” to solve our current healthcare problems.

 While early results from Washington showed the public option plans can have a moderate positive impact on healthcare costs, the experiment is in its infancy and challenges remain: many individuals reported confusion navigating the different networks and narrower choices of providers, and after 2 years, the voluntary participation in the public option is still low (11%). 

 In Colorado, which started its reform in 2019, only 15% of option plans met the premium reduction target by 2023. These findings are reported in a health forum published in the Journal of the American Medical Association (March 28) and offer cautionary tales about the overall effectiveness of public option plans in changing the current chaotic and fragmented system.

 Healthcare reform is complicated and politically challenging because it requires trade-offs that may be unacceptable to specific interest groups: private insurance corporations mostly driven by profit; providers concerned about reimbursements; patients are now consumers in a less than transparent market. The practice of medicine seems no longer an art or a science, but is now defined as a business, especially predatory now that equity firms are stepping in to buy out financially failing clinical practices. 

In this Land of the Free, we pride ourselves that Americans are able to “make choices” in healthcare, just like we would shop for goodies at a supermarket. The reality: choices, very limited; confusion, widely spread. Introducing a public option plan to “compete” with other health insurance plans may sound good, but it may not have a fighting chance: there is no guarantee that our politicians will continue to support it when the private health industry are the top lobbying spenders, and when its competitors can cherry-pick healthier members and put obstacles to medical services to minimize their own costs. 

Simply put, I’d much rather go with a single payer system: everybody is covered, with basic essential benefits, and with equal dignity. If the term “single payer” puzzles you, think of Medicare benefits funded by fair taxes and offered not just to seniors, but to everyone. If you hear that Medicare will go bankrupt in an x number of years, don’t panic. Any program, public or private, is always a work in progress, and we can adjust revenues and expenses, benefits and resources to make the program stay cost-effective and sustainable. Most of all, a Medicare-for-All will be simpler and less expensive to deliver than current health insurance plans that spend up to 15% of their revenues on administrative and advertising costs. It will also be more equitable – not a Cadillac treat for the rich and powerful, but leaving no one behind without preventive or essential medical services either. Some may call this “Socialist Medicine”, but with the majority of Americans believing that providing healthcare coverage for all is a government responsibility (according to a 2020 Pew Research Center survey) I call it democracy at its core. Although implementing a single payer program faces many challenges, let’s keep our eyes on the prize, for we cannot achieve the American pursuit of happiness without good and equitable health services for all.

  (Published in the Gazette Times, Corvallis, on April 25, 2024)