One Fund to Heal Them All: A Single-Payer National Health Insurance | Big Think

One Fund to Heal Them All: A Single-Payer National Health Insurance

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Publicly financed, privately delivered: Dr. Oliver Fein explains how healthcare financing reform is a pre-condition for delivery-system reform.

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Oliver Fein:

Oliver Fein, M.D., is a Professor of Clinical Public Health in the Department of Public Health at the Weill Medical College of Cornell University.

His research and policy interests include health system reform, national health insurance and medical education. Dr. Fein has been interested in access to care for vulnerable populations and the social responsibility of the Academic Health Center to its community. He has published work in ambulatory case-mix measurement, different methods of measuring social class and health inequalities, and comparative international health systems.

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TRANSCRIPT:

Question: What are some of the common arguments forwarded by opponents of a single-payer healthcare system?

Fein: Number one, that this is in some ways contrary to American culture that, you know, we are free and independent nation. Secondly that free markets which is what they usually are advocating are the best way to distribute resources within an economy and they argued that that would be best for health care. And thirdly, I think the problem is that they often represent those entities which indeed get the benefit from having our present system. Namely they are insurance companies, private health insurance companies, the pharmaceutical industry, those are the most common folks who speak against a Single-Payer National Health Insurance Program.

Question: What healthcare system do you propose?

ein: Okay, let’s start with what we’re calling a single-payer National Health Insurance Program and let me be very clear that that’s confusing to people. I’ve had people come up and tell me you mean I have to be single to qualify for your health plan? No.

What we are talking about is a program that essentially provides automatic enrollment for anyone who lives in the United States, that’s what real universal coverage is. Somebody presents to an emergency room they don’t have health insurance, let’s take the opportunity and sign you up right there because you should be automatically enrolled. There is no private health insurance company in the United States that would enroll you when you came to the emergency room.

The second principle is that the coverage should be really comprehensive. Everything from preventive care, through doctor, hospital, mental health, dental, to nursing home care all medically necessary services.

The third principal is that it should be financed by a public system in essence. The way in which we finance private health insurance today is using premiums. And premiums are really relatively unfair. The president of the company pays the same premium as the secretary yet their incomes are so widely different. Public financing means that it would be scaled according to income.

And, the fourth principle is that all of this should be done through a much more simple administration and that’s what single payer is. For instance, the Medicare program, which is our one example of a single payer program in the United States, has a 4% overhead, 3 to 4%, whereas private health insurance can be anywhere from 20 to 30%.

And finally, all of these should be delivered essentially through a, how to describe it, a private delivery system. It’s public financing, private delivery.

Let me say that in addition to that there should be free choice of doctor and hospital and really that’s what a single-payer program would offer. That, right now in private health insurance you are limited to a network of doctors and a network of hospitals. You have to pay, frequently, substantially more if you want to go outside that network, whereas in single payer you can go to any doctor and hospital.

So you might ask the question, “Is there any health insurance program in the United States that resembles what we are talking about?” And I would like to say, “Yes. It’s the traditional Medicare program.” It’s essentially a program that is publicly financed but privately delivered and that’s what we are talking about.

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