Think about it as Medicare for all, not just for the elderly.
And not just the limited, cash-strapped program that makes headlines now, but an enhanced Medicare that covers prescription drugs and catastrophic care, as well as pays doctors a fair wage for their services. All of this for no more money than the country spends now on healthcare.
Sound too good to be true? Maybe. But for years, independent analyses from the Congressional Budget Office and private consulting firms have found a single-payer, national health-insurance system, however controversial politically, could do just that.
And Wednesday, noting that "the 'health care mess' is too real for anyone to ignore," the prestigious Journal of the American Medical Association (JAMA) gave the medical world a jolt by publishing a proposal for a national health-insurance system that has been endorsed by more than 8,000 doctors. They include two former surgeons general.
Healthcare experts consider the move by the generally conservative journal to be one of the clearest signals yet that the US healthcare system is in need of an overhaul. While no one expects this particular US Congress to endorse a single-payer system, the JAMA decision does put the idea back on the map as a serious alternative.
"The thing is heating up, it really is," Dr. Henry Simmons, president of the National Coalition on Health Care in Washington. "[Healthcare is] going to be the transcendent domestic issue in the next election."
The editors at JAMA made it clear they aren't necessarily endorsing the idea. But they consider the healthcare crisis so dire that all ideas have to be seriously explored.
The American Medical Association, the largest doctor organization in the country, immediately distanced itself from the article. It noted that while JAMA was associated with the AMA, it is editorially independent. Indeed, the AMA has had a long-standing policy opposing a single-payer system.
AMA President Donald Palmisano said that while a solution is "desperately needed" to cover the nation's more than 40 million uninsured, a single-payer system is not the way to go.
"A single payer system would result in rationing of care, increased bureaucracy and stifling of innovation," says Dr. Palmisano. "It would demoralize doctors and patients."
Advocates of a single-payer national health system dispute that. They say patients would have more choice than they do now of doctors and hospitals, which would continue to be run privately under the system they're proposing. And they contend the services received would be more comprehensive for a fraction of the cost.
Currently, about 26 cents on every US health care dollar is spent on paperwork and administration. Replacing private health insurance companies with a single, government insurer like Medicare, which spends about 3 percent on administration, would save the country $200 billion dollars annually.
"The single payer system is the only one that's economically feasibly," says Dr. Richard Brown, a member of Physicians for a National Health Program, which wrote the proposal featured in JAMA. "And of course it's open, it doesn't exclude people because they're a bad health risk."
Currently, the United States is the only major industrialized country that doesn't provide some kind of universal coverage, even though it spends more than 14 percent of its GNP on healthcare. According to the World Health Organization, that's more than any other in the developed world and yet it remains the only one with tens of millions of uninsured. The quality fo care in the United States also fares only modestly when compared with other countries. Out of 181 rated by the WHO in 2000, the US came in 35, just two slots above Cuba.
Single-payer advocates acknowledge it remains a very controversial idea in the United States. But they point out that in the last 10 years support has grown, even in places traditionally opposed. In a fact sheet, the Physicians for a National Health Program note that "More than half of academic physicians, including most medical school deans, now endorse single payer [national health insurance,] as do 40% of small business owners. Polls have long shown that a majority of Americans favor some form of [national health insurance]."
Most health policy experts, including Brown, believe it still could be many years before the country is ready politically to institute a single- payer system. Currently, health insurance is provided by a mix of private, employment based insurers and a government safety net for the poor, as well as full coverage for the elderly. Health insurance is a multi-billion dollar business, with a powerful lobby on Capital Hill.
"I don't think right now we could move politically too far from that model," says Kathleen Stoll, director of health policy at Families USA, nonprofit health care consumers advocacy group in Washington. "The problem is that there's a tremendous hole between those that have coverage from their employers and those that are covered by the government."