A group of more than 2,000 physicians is calling for the establishment of a universal government-run health system in the US, in a paper in the American Journal of Public Health.
The new single-payer system would be funded mostly by existing US government funding. The physicians point out that the US government already pays for two-thirds of all healthcare spending in the US, and a single-payer system would cut down on administrative costs, so a transition to a single-payer system would not require significant additional spending.
Under the proposal, all US residents would be able to see any physician of their choosing in the country and be treated at any hospital. With guaranteed coverage and no co-pays, deductibles and premiums, patients would not have financial barriers to seeking care, which would lead to greater utilization of the system and improved health outcomes, argues David Himmelstein, a professor in the CUNY School of Public Health at Hunter College and lecturer on medicine at Harvard Medical School. The additional funds would be made up by modest tax increases in exchange for abolishing insurance premiums, deductibles and co-pays.
“We would have to abolish the insurance companies, there is no way around that,” Himmelstein said. The employees at the private insurance companies would be retrained for other jobs, he explains, and receive job placement assistance. The insurance CEOs, who earn multimillion dollar salaries, would not get comparable job placement, Himmelstein said wryly.
Fees for medication would be negotiated with pharmaceutical companies the same way other countries with single-payer systems already negotiate for lower cost medications. Currently, US drug prices are some of the highest in the world.
The American Medical Association (AMA), which is the largest organization of physicians in the US, has opposed the idea of a single-payer model. When contacted, the AMA pointed to its policy regarding evaluating health reform proposals, which states in part that: “Unfair concentration of market power of payers is detrimental to patients and physicians, if patient freedom of choice or physician ability to select mode of practice is limited or denied. Single-payer systems clearly fall within such a definition and, consequently, should continue to be opposed by the AMA.”
For Himmelstein and the other writers of the editorial, the biggest indicator of change seems to be the talk of a single-payer system in the presidential primaries which has brought attention back to the issue.
While Himmelstein acknowledges that the physicians’ proposal would meet with political and business interest opposition, and he can’t say when such a system would realistically have the political backing needed to be implemented, he is hopeful that as more Americans view a single-payer system favorably, pressure will continue to mount on the government.
Proposing a single-payer system in the US is not new. Vermont previously attempted to implement a single-payer system, and Coloradans will vote this November on whether to institute a single payer system statewide. But Himmelstein said this type of reform can’t be done state by state.