Health care issues and policies have been or should be a concern of every family. Most of us will agree that all Americans should be able to gain access to health care. What is not always appreciated is the difference between "having access" and "gaining access."
Gaining access to healthcare requires being able to consistently overcome a number of barriers, including the ability to pay for care. Being treated in an emergency room is often a temporary solution to health care problems and does not allow one to "gain access" to health care.
Some studies show that half of all medical care in the United States is provided in emergency rooms, where doctors are obligated to treat, regardless of an individual's ability to pay. Healthcare in the emergency room is far from desirable and is a very expensive form of treatment.
Today, in the United States, 30 million people have no health insurance, and another 30 to 60 million have health insurance that is woefully inadequate. Health care costs are the number one reason for personal bankruptcy with close to a million families going bankrupt each year due to health insurance coverage that is inadequate. And those numbers are growing every year.
Healthcare costs in the United States are nearly twice as much per person when compared to other developed countries. Studies that look at healthcare outcomes show healthcare in the United States is far inferior to most other developed countries.
So why are our costs so high and outcomes so poor? And why are we the only developed country that does not provide healthcare coverage to all of our citizens?
The answer is simple. In the U.S., the healthcare system subsidizes the health insurance and pharmaceutical industries. Both make huge profits while providing barriers to reasonable care.
Analysis of the 2018 study by the Mercatus Institute shows that 2 trillion dollars could be saved over a 10-year period by instituting a single payer healthcare system in this country. Yet the study's results have been spun by some to claim that single payer would cost us an additional 32 trillion dollars over 10 years.
No analysis is needed to determine that a single payer system would reduce suffering and save lives.
So who loses and who wins by changing to a single payer system?
The biggest losers in a single payer system are the health insurance and pharmaceutical industries and their stockholders. Some might argue that physicians and hospitals could be among the losers because they might be expected to accept lower reimbursement rates. The biggest winners in a single payer system would be the American people, especially those who currently have no or inadequate health insurance. Other winners would be American workers who currently have good coverage through their employers and as a result are unable or unwilling to make a change in their job due to fear of losing that coverage. Businesses and the self employed would be winners because they would no longer have to purchase health insurance coverage for their employees or for themselves.
Many agree that physicians and other health care professionals would also be among the winners because managing health care would go back into their hands and would not be compromised by the whims of health insurance or pharmaceutical companies.
In "government run" health care, the government doesn't run the "health care" part, just the "funding" part. No longer would healthcare be controlled or compromised by the health insurance or pharmaceutical industries.
So if a single payer system is both more desirable and more affordable, there is one final question. How do we get there?
Tweaking the current system, or incremental change, is not likely to be successful. The resources and lobbying efforts of the health insurance and pharmaceutical industries are far too powerful and a drawn-out process favors the big money. Those who advocate for incremental changes are well aware of this fact.
What is needed is an assertive transformation of our health care system. All objective analyses support the value and the quality that a single payer healthcare system could provide. Our elected officials simply need to have the courage to stand up to the opposing industrial forces and do the right thing for the people.
Joshua Gear, M.D., is a child and adolescent psychiatrist in Portsmouth.