Speak Up: Talking About Single Payer

on the WardsDesireé Conrad, Anna Zelivianskaia

University of Illinois-Chicago College of Medicine

Class of 2016

What is single payer?

• SINGLE-PAYER: A way of financing healthcare for the entire population in a geographic/political entity. And financing is different from delivering healthcare. A publicly financed system can be delivered two different ways:

• Private care delivery: Traditional Medicare, FFS Medicaid, Canada

• Public care delivery: VA, Military health system, Indian Health Service, Great Britain

Either option eliminates private health insurance except for supplemental benefits not covered in single-payer program.

Opportunities and Barriers to Promoting Single Payer

• Opportunities: physicians commenting on problems with U.S. healthcare, seeing un- or underinsured patients in clinic, talking about the costs of various medical tests

• Barriers: I’m a lowly medical student and there’s a hospital hierarchy, I don’t know where to start, I don’t want to seem like I’m advertising an organization when I should be focused on patient care

Learn the Facts

• The U.S. spends approximately 2x as much per capita on healthcare spending compared to other developed nations (exact comparison figures vary by country)

• Health care costs make up 17.7% of the U.S. GDP while the average developed nation spends 9.3%

• Yet we have the lowest life expectancy at 78.7 years compared to UK, Canada, France, Italy, Germany, and Sweden

• We rank 26th out of 36 member countries in life expectancy Note: Data are for 2011 or most recent year

availableSource: OECD report, 2013

Case Study: Chicago

Geography of Disparity

Age-Adjusted Female Breast Cancer Mortality for Chicago, Per 100,000 Population. 2000-2005Prepared by The Sinai Urban Health InstituteThanks to Ed Weisbart, MD and David Ansell, MD

High breast cancer mortality, Non-African American communities

High breast cancer mortality, African American communities

Hospitals with American College of Surgeons Approved Cancer Programs

•Bottom line: MAJOR HEALTH DISPARITIES STILL EXIST SO

WHAT ARE WE PAYING SO MUCH FOR…?

Growth of Physicians vs Administrators

Data updated through 2013Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS

Gro

wth

Sin

ce

19

70

Physicians Administrators

3000%

2500%

2000%

1500%

1000%

500%

01970 1980 1990 2000 2010

Single-Payer Savings• Administration (~16%): focused on assuring care

and payment, not avoiding “risk”

• For entire health care system: ~ 30-40% savings

Insurance Administration Managed Care Administration

No:• Exorbitant exec salaries,

marketing, lobbying, profit• Underwriting, insurance

reserves, broker fees, exchange fees

• Eligibility determination, narrow networks

• Care managed by doctors & hospitals, not health plans

• No complex financial incentives and risk adjustment

• Simplified data for QI• No distortion of data due to

“pay-for-documentation”• Much less fraud and abuse

*Slide taken from presentation “The Business Case for Single Payer by Steve Kemble, M.D., March 11, 2014

Available at www.pnhp.org

It’s Good for Business!

• Reduces direct costs:

• no health insurance administrative costs or retiree benefits for businesses

• bulk purchasing

• negotiated prices

• Reduces risk:

• Access to healthcare for all mitigates the outliers who require more costly care

• Better access to outpatient care

• More incentives for preventative medicine

*Slide adapted from presentation “The Business Case for Single Payer by Steve Kemble, M.D., March 11, 2014

Available at www.pnhp.org

Common Arguments Against Single Payer

Cost• It will not save money.

• It will decrease physician salary.

• Why should I pay for someone else’s care?

• It stifles the free market and is against capitalism.

Care• Quality of care will suffer.

• It will ration care.

• It will take medical decisions away from physicians and patients.

• It will hamper medical research and technological innovation.

Counter Arguments for Cost

• It will not save money.• Decreased administrative cost, bulk purchasing, negotiated pricing. IOM estimates $500B lost annually due to

diminished productivity of an uninsured population.

• It will decrease physician salary.• When compared to other industrialized nations, average US physician earning is more. However, this is not a fair

comparison when less than ½ the physicians are specialists in other nations. In US, pay for primary care pay lags significantly behind specialty care. Furthermore, physicians under single payer systems do not have as high of cost for malpractice nor as high of education debt burden. The average physician salary in Canada is $307, 482.

• Why should I pay for someone else’s care?• You already pay for the uninsured. Unfortunately, it is at a much higher cost when the uninsured are seeking

urgent care. Urgent care costs are significantly higher than routine primary care visits.

• It stifles the free market and is against capitalism.• In more than 90% of measured areas in the US, competition is restricted to less than three private insurers.  An

unrestricted free market would price many people out of insurance.

Counter Arguments for Care

• Quality of care will suffer.• Quality of care will improve due standardization of quality improvement initiatives and EBM. The uninsured

delay care for chronic conditions leading to poorer outcomes and more preventable deaths.

• It will ration care.• Single payer system would lead to more equitable and efficient distribution of scarce health care resources

and services.  

• It will take medical decisions away from physicians and patients.• Under a singly payer system, health care services are privately delivered by physicians but publicly financed

by the government. This means clinical decisions are still made by the provider and the patient. It will also increase patient autonomy by eliminating networks and allowing patients to choose their physicians.

• It will hamper medical research and technological innovation.• Most medical research is currently funded by NIH (a government agency). Furthermore, the inappropriate

use of technology will be reduced leading to more practice of evidenced-based medicine.