Single-payer reform as an immediate demand

On June 19, thousands of activists rallied in San Francisco and New York City to demand a universal single-payer health system. The protests were called by labor unions, progressive physicians’ groups and allied community organizations in response to the deepening health-care crisis facing workers in this country.

Single-payer is a system of national health insurance that organizes health financing through a single public agency. Single-payer care removes private insurance companies as arbiters of who does and does not receive adequate care. A 2003 proposal by the Physicians’ Working Group for Single-Payer National Health Insurance published in the Journal of the American Medical Association claims that a single-payer program would save at least $200 billion annually by eliminating high profits as well as the marketing and overhead costs associated with the private insurance industry.

Single-payer health insurance is currently utilized by Canada, Japan, Australia and many western European countries. The disparity in the quality and accessibility of health care between those countries that have single-payer insurance and the United States is glaring. Physicians for a National Health Program estimates that the United States spends more than twice as much as most other industrialized capitalist countries on health care. Yet despite spending $7,129 per capita, the United States underperforms on major health indicators such as life expectancy, infant mortality and immunization rates.

Most supporters of single-payer insurance have endorsed the United States National Health Insurance Act (H.R. 676). The bill is popularly known as “Medicare for All.” The bill has 88 congressional cosponsors and a slew of labor endorsements from 308 union organizations in 44 states, including 22 state AFL-CIO affiliates. Some of the international labor unions that have endorsed include the Electrical Workers, California Nurses Association, Auto Workers and the Coalition of Black Trade Unionists.

H.R. 676 is a progressive piece of legislation, and its passage would represent a big victory for workers and the oppressed. Every person living or visiting the United States is eligible for coverage under the act. The proposed program covers most medically necessary services including primary care, emergency care, prescription drugs, mental health services and long-term care. Dental and eye care, inpatient and outpatient care, and durable medical equipment are covered by the act as well. The patient is not charged any co-pays or deductibles, and private insurers are prohibited from selling any coverage that duplicates the benefits covered by the act.

Labor organizations and community activists are right to rally around the passage of this legislation as a genuine reform of the U.S. capitalist health care system. H.R. 676 represents a substantial improvement over anything the Democratic or Republican presidential candidates are proposing as solutions to the current health-care crisis.

Despite its progressive nature, however, H.R. 676 is not a cure-all for everything that ails the U.S. health-care system. Single-payer leaves the actual provision of care in the hands of mostly private doctors, hospitals and pharmaceutical companies. It is true that single-payer care will reduce costs by using its economy of scale to bargain for lower reimbursements for care and prescription drugs. But it is also true that the fundamental reason private insurance is so expensive is because of private providers and pharmaceutical companies.

According to Families USA, the top seven U.S.-based pharmaceutical companies brought in $190 billion in 2005 revenue. A 2002 study titled “Profiting from Pain: Where Prescription Drug Dollars Go” found that 27 percent of drug company revenues was spent on marketing and advertising. Eighteen percent went to corporate profit, and just 11 percent was spent on the research and development necessary to find new cures.

Private hospitals are similarly wasteful and consume far more dollars than is necessary to provide quality care to patients. A 1993 study published in the New England Journal of Medicine found that private for-profit hospitals incur administrative costs at a rate that is $857 higher per discharged patient than public hospitals, despite the fact that public hospitals disproportionately care for more uninsured at-risk patients.

While single-payer insurance would fix some of the most glaring problems in the U.S. health-care system, the inefficiencies of private delivery of care could prove a significant strain on the public insurance system. The exorbitant profits and marketing costs associated with big pharmaceutical companies and private hospitals would unnecessarily tax health-care allocations and provide fodder for right-wing attempts to undermine the system. Single-payer insurance represents an immediate and progressive working class demand, but what workers really deserve is a humane system of health care that entirely removes the profit motive out of the equation from financing to delivery.

Next: Socialized medicine: the health-care revolution workers deserve.