In the US, a single-payer or national health plan is usually regarded as politically unfeasible. It may not be the politicians who lead the charge, however. It is the people working in the system, specifically physicians, who are being squeezed by the increasing number of rules, concurrent reductions in income and patients who can’t afford them, that are looking for solutions.
A group of Harvard Medical School physicians wrote an editorial for the American Journal of Public Health advocating a national health plan, one that simplifies payment for healthcare providers and organizations and opens access to care for all. The authors suggest creating a seamless system with multiple points of access largely financed with public funds
In a critique of the Accountable Care Act, the authors say that the ACA has fallen well short of its promise to make healthcare affordable.
“A decade from now, according to the Congressional Budget Office, 27 million Americans will remain uninsured despite full implementation of the law. Many more are underinsured or constrained by “narrow networks” of providers that limit choice and rupture longstanding therapeutic relationships. Doctors and nurses contend with growing requirements for mind-numbing electronic documentation1b in a health care marketplace increasingly tilted toward giant insurers and hospital conglomerates that amass power through consolidation. Finally, the system’s administrative complexity, which robs patients and providers of time, money, and morale, was further fueled by the ACA.”
The authors write for a group of 2,000 physicians who are advocating for a national health plan, the Physicians for a National Health Program (PNHP).
The ACA moves the country in the direction of some elements of single payer by incrementally driving providers to bundled payments. The country’s healthcare bill is increasingly covered by the government as the number of people covered by private, employer coverage falls. The government – federal, state, local – now funds about 50% of care, and that percentage has continued to grow over the last 20 years. The people who crafted the ACA legislation created a reimbursement system that edges the US closer to single payer, and makes payment justification through documentation requirements so unwieldy as to interfere with the practice of medicine.
Another report released last week showed that hospitals with higher revenue did not perform better on a group of outcomes. This study of several hundred California hospitals supports the idea that pricey healthcare is not better healthcare.
These two unrelated studies move toward the idea that a simple, low-cost system focused on patient care might better serve patients and the economy. Healthcare is close to accounting for 20% of GDP in the US, and that is a mighty engine for growth but also a very dangerous place because it encourages a lot of entrenched interests to preserve their piece of the pie. From a broader perspective, healthcare may also be siphoning resources that could be used to bolster other industry sectors to create a more balanced and resilient national economy.
In a post from the last Health Wonk Review, Health Access blogger Anthony Wright crafted a well-reasoned case for ways to move the single payer discussion forward in politics. Wright, as the Executive Director of Health Access California, plays in political waters every day to move forward broad visions within political realities. Single payer, as he points out, is a term to describe a healthcare system that is “more universal, progressively financed, cost-effective, streamlined and efficient, comprehensive, and prevention-oriented.”
Those goals are all achievable, over time, incrementally. But they require buy-in from an entrenched sector of the economy whose lifeblood is dependent on a massive influx of dollars from all participants to keep it alive.