Single-payer health care would save billions for Massachusetts

David U. Himmelstein, MD & Steffie Woolhandler, MD, Boston Globe, May 30, 2012 The House and Senate health care proposals would set imaginary limits for spending growth enforced by secret “improvement plans” and wrist slaps for hospitals that overcharge; establish tiered payment schemes to consign the poor and middle class to second-tier hospitals and doctors; push most residents of the Commonwealth into HMOs (oops, we forgot, now they’re called “accountable care organizations,” or ACOs); and wipe out small doctor’s offices by “bundling” their pay into ACO payments. ... Single-payer

Nurses' Role

Himmelhandler of course forget about the role of nurses in bringing power to bear in creating our new, just healthcare system, and in providing necessary primary and specialized care now and in the future. We also have to realize the far greater threat that ACOs may present than merely reborn HMOs. - Sandy Eaton, RN

Not Just Your Mother's Medicare

To explain simply what is meant by "single payer," we often allude to an "Improved Medicare for All." That seems to suggest that we merely need to tweak Medicare and then provide it to everyone - that simply eliminating private insurers is all we need to do. This article by PNHP co-founders David Himmelstein and Steffie Woolhandler briefly describes how the single payer model is much more than that, especially pointing out how it would be tremendously effective in slowing the nearly intolerable increases in health care spending, while dramatically improving the functioning of our health care delivery system. First, a little background. When the Massachusetts health reform legislation was ready to be enacted, it was criticized for failing to address one of the most important reasons for reform - it did not include effective measures to contain costs, a flaw challenged by single payer supporters. Rather than taking another look at single payer, Gov. Romney's advisor, MIT economist Jonathan Gruber, famously said that first we should get everyone covered by passing this, and then we'll work on controlling spending. Of course not everyone is covered in Massachusetts, while cost increases continue out of control. In response, the Massachusetts House and Senate have prepared separate but similar bills to control spending, while ignoring the remaining uninsured. Instead of adopting structural changes that would reduce waste - as Himmelstein and Woolhandler recommend - they would apply spending restrictions that could threaten solvency of components of the health care delivery system, while compounding the problems of patient access already evident in the inadequacies of the primary care infrastructure. As everyone knows, the Affordable Care Act (ACA) was patterned on the same model as used in Massachusetts. Single payer advocates were vehemently proclaiming that ACA would leave too many out of the system, and that it would fail to address rising health care costs - the two primary problems that motivated reform. But we were excluded from the process. As our members of Congress toiled over the markup of the legislation, measures were included that nominally would control costs. However, with the possible exception of the Independent Payment Advisory Board (IPAB), none of the included measures would have a significant impact on health care costs. Even the IPAB would have the serious flaw of cutting solely Medicare and not private insurer payments to the health care delivery system, threatening underfunding and likely impairing access due to the exodus of physicians from the Medicare program. The primary reason that the meager measures to contain spending are inadequate is that ACA left in place and built upon our existing dysfunctional financing system with its profound waste. What we needed instead was a complete overhaul of the financing infrastructure, including not only changing to an administratively simplified single payer but also measures such as those listed by Himmelstein and Woolhandler. Eliminating private insurers and switching to a single public insurer is the most important and effective measure of single payer, but the other measures are essential if we want to join the other wealthy nations that provide quality care to everyone at an average of half of what we are currently spending. When you advocate for single payer by pushing an "Improved Medicare for All," be sure in the same breath to let your listeners know the extent of our recommendations: "An Improved Medicare for All that would totally overhaul our dysfunctional financing system so that it works best for patients." In this age of sound bites, if you have another breath, you can point out that single payer would also have a highly favorable impact on the health care delivery system, by enhancing primary care, and by efficiently expanding facilities and high-tech capacity based on medical need instead of profit and extravagance. Above all, it's crucially important to communicate that single payer is not just your mother's Medicare. - Don McCanne, MD, Physicians for a National Health Program