Single-payer health care: What it is, what it isn't

Dr. David Dvorak is an emergency room physician. He supports a single-payer system for Minnesota and wants to make one thing clear: "single payer" doesn't mean socialized medicine.

In Germany, for instance, hospitals and doctors compete for customers, and the market dictates the cost of what they provide. The government pays the bill because health care isn't viewed as discretionary but as a basic right. Every taxpayer pays in, according to ability and regardless of illness or age. This creates a vast pool, to borrow a term from the insurance industry, and the larger the pool, the smaller the risk that each participant poses to everyone else. Now that's an insurance plan!

What bothers Dvorak is that in this country health care is such a hodgepodge. About half of us get coverage through our employers. There are nonprofit insurers and for-profit insurers. The latter group spends about twice as much in overhead as their nonprofit peers. If you're uninsured because you're self-employed, unemployed or have a preexisting condition and are 19 or older, well, that's too bad — but not at all surprising. Fifty million Americans are in the same predicament. Health crises are now the No. 1 cause of bankruptcy in the United States.

Veterans Affairs and Medicare take care of the sickest among us yet somehow manage to deliver health care at the lowest cost. Could that be, at least partly, because they've eliminated the middleman? The nonpartisan U.S. General Accounting Office concluded that a system like Germany's would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Critics believe that single payer would put an end to innovation. It's a false argument to begin with, but look at the record: Shiny new stents, scanners and specialists don't automatically deliver improved health. Moreover, gains produced by medical breakthroughs are erased by such mundane realities as this: When people lose their health coverage, they put off going to the doctor until the cost to heal them is through the roof. Who pays? Taxpayers. Fact is, business pays less than 20 percent of our nation's health bill, while 60 percent is funded by taxes and the rest is out-of-pocket.

We are spending twice as much as other wealthy democracies — yet our health outcomes, including life expectancy and infant mortality, keep heading the wrong way compared with theirs. Meanwhile, insurance companies and their top executives are raking it in. It takes a certain kind of smarts to deliver shareholders the handsome rewards they've come to expect from this industry, rewards that also accrue to the benefit of those brainy executives, whose salaries are dwarfed by what they receive in stock options.

In 2009, when the rest of the nation was mired in recession, the New York Times asked the UnitedHealth compensation committee why CEO Stephen J. Hemsley had been awarded $100 million in stock options that year. The committee praised their man for "enhancing the Company's reputation, ethical culture and tone at the top." The Times noted that Hemsley's predecessor, William W. McGuire, "had stepped down in a scandal over his stock options."

UnitedHealth employs ordinary people, of course. Jobs are important. But do these jobs grow the economy in a meaningful way? Do they create new treatments or diagnose tumors or comfort an ill patient?

Many studies have proven that single-payer systems are vastly more efficient and fair than our own combo platter. The Affordable Care Act reforms a system that needs to be replaced. In 2017, states will be allowed to opt out. Maybe, on this issue, the agendas of left and the right will align. Conservatives who like taking power from the feds and liberals who see health care as a human right might just see eye-to-eye enact the first single-payer system right here in Minnesota.

That's how it started in Canada. Dvorak likes to point out that when asked in a nationwide poll to pick from a star-studded roster their greatest national hero, Canadians chose Tommy Douglas, who set up a single-payer health care system in Saskatchewan that was so successful the rest of the country wanted in.

Something else Dvorak wants to clarify: He's not some renegade outlier. Polling shows not only that two-thirds of Americans support single-payer, but that 59 percent of American physicians do, too.

Why didn't you know that? Spin. Insurance companies spent $1.5 million a day lobbying to ensure that the ACA would pose no significant threat to its presence in health care. That's what I mean by smart.

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Bonnie Blodgett is a St. Paul writer.