Is Single Payer Our Health Salvation?

http://www.nytimes.com/2016/05/24/opinion/is-single-payer-our-health-salvation.html

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To the Editor:

Re “Why a Single-Payer Plan Would Still Be Really Costly” (The Upshot, May 17):

As a physician who favors a single-payer plan, I cannot disagree with your analysis about the high cost of moving to this type of health care plan.

Our present system is really all about profit — from the medical device makers to the pharmaceutical industry to health care workers and medical administrators to insurance companies. The challenge to bring down costs, under this system or single-payer, is large.

Yet we have seen what the free market has done over the last 70 years, and it has not been a success in terms of cost control. Indeed, health care costs are going to get significantly worse if we continue our present system, a combination of private and government payment.

Only a single-payer system has any chance to control costs yet guarantee that all citizens will have health care coverage. To stand pat with free-market fervor or to go backward, such as eliminating the Affordable Care Act, will deprive many of medical care while still driving up costs.

In the long run, the present system will cost far more than a single-payer option, and the sooner we proceed in that direction the better.

GREGORY L. SHEEHY

Middleton, Wis.

The writer is a retired internist.

To the Editor:

It’s time to debunk the myth that a single-payer system must eliminate the health insurance industry. That industry works with self-insured employers not as an insurer but as an administrator, making sure that the self-insured employer lowers health care costs through provider contracts, benefit plan design and insights that identify patients requiring proactive steps to reduce long-term medical costs.

The industry has been very successful in enabling self-insured organizations to reduce and contain costs.

The federal government could become a single payer (for one national risk pool or 50 state pools) administered through the private-sector insurance companies acting as benefit administrators, just as they do for self-insured employers.

The government would require common forms and do all contracting with providers (eliminating a lot of administrative complexity). The private-sector companies would compete on “getting the most from your benefit spending,” just as they do with self-insured employers.

As long as we hold on to the myth that health care reform eliminates an industry, there will be no reform.

MARY KAY PLANTES

La Jolla, Calif.

The writer is an economist and business strategist with board, management and consulting experience in the health care industry.

To the Editor:

Our health care costs more because our administrative costs, a result of a financing system that relies on for-profit insurance companies, are so high. Some of those costs are borne by physicians, who must pay for complex billing systems, denial management, preauthorization requirements, collections management and bad debt, as well as devoting patient time to discussing insurance coverage rather than medical issues.

If we substantially decrease those costs to physicians, as a single-payer system would do, we could decrease insurance payments to physicians and still give all of them a raise. No economic miracle involved; just a matter of the people who do the work, rather than a wasteful middleman, taking home the money.

ANNE SCHEETZ

Chicago

The writer is a retired internist.

To the Editor:

If a single-payer system is put in place, beware: Not only will some hospitals go out of business and doctors default on their mortgages, but far worse is in store. We all as patients will suffer grave consequences.

It takes a long time to school and train a competent doctor, at a very high economic cost. Most of the well-trained, middle-age doctors are still in practice, so the absence of well-trained physicians has not been seen or felt by the general public yet.

But we doctors ourselves shudder to think “who will take care of us when we get sick?” Are we prepared for the real answer?

ROBERT J. LEON

Hoboken, N.J.

The writer is a cardiologist.