HEALTH

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff Ask Dr. K

I’ve heard the term “sin­gle-payer health care” a lot in re­cent years. What does it mean?

Sin­gle-payer health care is a term used to de­scribe a sin­gle, uni­fied health care in­sur­ance sys­tem. It means that all of your med­i­cal and health care ex­penses are cov­ered by one or­ga­ni­za­tion — the gov­ern­ment.

But a sin­gle-payer sys­tem does not mean that the health care pro­fes­sion­als (like doc­tors) and in­sti­tu­tions (like hospi­tals) are owned and run by the or­ga­ni­za­tion that pays for care. Most sin­gle-payer sys­tems pro­posed for the U.S. an­tic­i­pate that the health care pro­fes­sion­als and in­sti­tu­tions would re­main in the pri­vate sec­tor. It’s like Medi­care for se­niors: Se­niors get their care from pri­vate doc­tors and hospi­tals, but the sin­gle payer (the fed­eral gov­ern­ment) pays most of the bills, with pa­tients pay­ing a frac­tion.

In con­trast, the ex­ist­ing health care sys­tem in the United States is a mul­ti­payer sys­tem. There are sev­eral in­sur­ance pro­grams funded by the gov­ern­ment, such as Medi­care and Med­i­caid. There are many pri­vate health in­sur­ance com­pa­nies. Many peo­ple have their health ex­penses cov­ered by more than one in­sur­ance com­pany, of­ten a com­bi­na­tion of a gov­ern­ment pro­gram sup­ple­mented by a pri­vate in­sur­ance pro­gram.

And, of course, 30 mil­lion peo­ple have ab­so­lutely no health in­sur­ance, gov­ern­ment or pri­vate. That’s true even though the Af­ford­able Care Act (ACA) — in­for­mally called Oba­macare — has pro­vided in­sur­ance to more than 20 mil­lion pre­vi­ously unin­sured peo­ple. But it was never de­signed to cover ev­ery­one, and it hasn’t.

In a sin­gle-payer health care sys­tem, a sin­gle pub­lic or semi-pub­lic agency fi­nances health care. In most mod­els of a sin­gle-payer sys­tem, ev­ery­one is cov­ered. This gen­er­ally in­cludes ex­penses for doc­tors, hospi­tals, long-term care, pre­scrip­tion drugs, den­tists and vi­sion care.

Some peo­ple think the U.S. would be bet­ter off un­der a sin­gle-payer sys­tem. Why? For one thing, we spend a lot of money ad­min­is­ter­ing our com­plex health care sys­tem. Be­tween 20 to 30 per­cent of ev­ery health care dol­lar goes to­ward ad­min­is­tra­tion. So that money is not avail­able to pay the doc­tors and hospi­tals, or to pay for di­ag­nos­tic tests or medicines.

In coun­tries with sin­gle-payer sys­tems, the ad­min­is­tra­tive ex­penses are much lower. In other words, more of their health care dol­lar ac­tu­ally pays for what it’s sup­posed to: health care.

Op­po­nents of a sin­gle-payer sys­tem are con­cerned about two things. First, they are wor­ried that the to­tal costs of health care might rise. That’s be­cause, they ar­gue, the cur­rent mul­ti­payer sys­tem en­cour­ages com­pe­ti­tion, and com­pe­ti­tion drives down costs.

Se­cond, they worry that the qual­ity of health care might suf­fer, be­cause com­pe­ti­tion also drives im­proved qual­ity of care. Whether these con­cerns are valid is the sub­ject of heated de­bate among health ex­perts.

For us as in­di­vid­u­als, would a sin­gle-payer sys­tem cost us more or less? It surely would re­quire higher taxes, since the gov­ern­ment needs the rev­enue to pay our health ex­penses. But to­day most of us get health in­sur­ance through our em­ploy­ers, and those ex­penses would be re­duced. Sev­eral sin­gle-payer pro­pos­als cal­cu­late that tax­pay­ers would ac­tu­ally save money. That could be true, but the devil is in the de­tails.

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