Truth or Fiction?   Rocky Mountain News Editorial, 8/2/07

Myth: Single Payer health care is more costly than privatized market-driven health care.

The push to privatize all health care, including Medicare and Medicaid is the wrong way to go. Privatization is more costly, and results in higher overhead/administrative costs?averaging 15 to 20 percent ? than traditional Medicare or Medicaid?averaging 2-4 percent overhead.

Half-truth: The Single Payer proposal would eliminate Medicaid.

The Colorado Single Payer reform proposal is the only one that has the ability to overcome the inefficiencies and high administrative costs of the current complicated Medicaid and Medicare  programs. Colorado Medicaid alone has 20 different coverage categories, each with lengthy applications, complicated means testing, disability reviews, and up to six-year wait lists. The Colorado Health Services Single Payer proposal calls for federal waivers to fold Medicare and Medicaid monies into a state health care trust, to be administered cost-effectively as a single-risk-pool insurance.

Myth: "Massive tax increases" and "medical rationing" would occur with Single Payer health care.

Single Payer health care will benefit the poor and middle working classes who currently bear the burden of a higher percentage of out-of-pocket health expenses and taxes to subsidize health tax shelters (HSAs) that benefit the rich. Under the Colorado Health Services Plan everyone earning less than $100,000 would pay less than they currently do in overall out-of-pocket health costs, premiums and all taxes.

Health care rationing occurs with private health plans, not with Single Payer. Single Payer?s much higher savings in administrative costs permits better health benefits for all than currently available under any private insurance plan.

Medical rationing is currently the norm in U.S. health care. "Unsurance" describe the typical private coverage held by most people, typifying a state of under-insurance. We are unsure that we will be covered for even one illness - after that, we either die or lose our house and belongings to bankruptcy. We become part of the statistical 50% of personal bankruptcies resulting from unpaid medical bills. AND we become "a pre-existing condition"?no longer eligible for coverage.

Myth: "Consumer-driven" health care with catastrophic insurance and health savings accounts (HSAs) provides the best health care access.

Catastrophic health plans with high-deductibles result in high individual out-of-pocket medical bills. Out-of-pocket medical expenses rose 59%, and unpaid medical bills increased 60% between 1995 and 2005 (reported by the American Hospital Association). One effect is that some hospitals now require up-front payments from individuals with high-deductible insurance. The cost of "uncompensated care" to hospitals and providers is ultimately shifted back to taxpayers and individuals.

Catastrophic coverage requires prohibitive out-of-pocket expenses for all but the financially well-off. Health savings accounts (HSAs) attached to catastrophic plans shift still more costs to poor and middle-class workers to subsidize tax credits for the rich. Reduced money in the health care system due to subsidies for private health insurance, etc. is ultimately recouped by raising health costs for everyone.

The truth is, taxpayers now pay over 60% of all health costs, enough to cover everybody with greater benefits under a single payer program if we eliminate the administrative waste of over 1500 private insurances with 17,000 different plans that account for over 30% of all U.S. health care costs.

RMN: California voters rejected a single-payer ballot initiative in 1994.

Yes, California voters did reject a single payer proposal in 1994?after a huge fear campaign was waged by the private insurance industry. However, California?s legislature passed a single-payer health care plan in 2006, and Gov. Schwarzenneger vetoed it. He then proceeded to introduce his own proposal, reinserting the costly middle men - private insurers.

There is a high cost to all for privatized health coverage. Medicare prescription drug reform in 2003 costs taxpayers billions of dollars in subsidies and increased profits guaranteed to insurance and pharmaceutical industries. These big-money lobbies wrote the measure to insure their bottom lines instead of people.

California nurses addressed the corrupt effect of these big-money lobbies by running an initiative in 2006 for public financing of campaigns. In order to achieve meaningful health care reform, it is necessary to eliminate big-money influence from policy-making?a reason to encourage  candidates to swear off of lobbyist contributions and support public campaign financing.

Myth: This proposal "would allow the rest of the country to play Coloradans for suckers...Out-of-staters who have medical insurance but don?t want to pay their out-of-pocket costs... and immigrants" will storm our borders "to get medical care at Colorado taxpayers? expense" by obtaining "a fake Colorado ID" or checking in "at an emergency room."

There is a residency requirement for coverage under the Single Payer plan.

There is nothing preventing the uninsured from arriving in Colorado now - in fact, we have over 770,000 of them. If every resident had access to primary preventive care under Single Payer health care, it would save all taxpayers the cost of more costly long-term chronic care, emergency crisis care, and enhance public health initiatives that forestall pandemics.

If Colorado were successful in creating a true comprehensive single-payer program it would improve the health of all and the health of the economy, and other states would likely follow our reform model. Colorado would also become a desirable location for businesses, which would be relieved of the burden of managing employees? health care plans, and therefore able to better compete in the global economy. More probably, because of a better state health care climate, businesses would pour over the borders to bring more jobs to our state.

Myth: "...a 15-member government board would set reimbursements rates for doctors and other medical providers.."

The News misreads the "governing board" as "government board." There will be public oversight of the governing board, which will likely be comprised of providers and consumers, who will determine fair reimbursement rates annually.

Containing overhead costs to 5% is very doable, as proved by traditional Medicare and Medicaid, whose overhead costs are 2-4%. The News underestimates what a cost savings there is from eliminating $3.8 billion in excessive overhead costs of multiple private insurances. That is the cost savings cited for the state of Colorado in the 2003 study "Administrative Waste in the U.S. Health Care System in 2003" ? a state-by-state analysis of savings with single-payer health care. (New England Journal of Medicine, 8/21/03)

Myth: "Patients with chronic illnesses who now depend on costly medications" will experience rationing of meds.

An advantage of single-payer health coverage over every other proposal is that everyone would have access to primary, preventive care, which eliminates the much higher cost of both long-term chronic illness and delayed emergency crisis care. The high cost of medications under our current system would be significantly reduced by negotiation of bulk drug prices.

Myth: Single Payer health care would be a "state-run medical monopoly."

Speaking of inflationary private U.S. health insurance, longtime editor of the New England Journal of Medicine and professor at Harvard Medical School, Dr. Arnold Relman in 1980 warned about the rise of a new, powerful U.S. "medical-industrial complex." He said such commercialization of medicine is neither in patients' nor society's best interest, and undercuts the ethics of the profession

In truth, the medica-industrial complex comprised of over 1500 private insurance corporations, is responsible for escalating health costs and decreasing health care access.

Truth: The Lewin Group's preliminary estimate suggests that this plan would save $1.7 billion over the first year it's in place, roughly 5.6 percent of medical costs in this state, by eliminating insurance premiums paid by workers and businesses, among other things.

Single payer health insurance ?the concept of public payer and private providers ?permits true free choice of providers and hospitals, even as it eliminates enormous administrative waste and cuts out-of-pocket expenses for the vast majority, including employers and employees.

Single Payer health care would herald a new era of quality-centered, instead of profit-centered, health care.

Myth: The Rocky Mountain News asserts that "Federal law requires ERs to treat any patient who arrives at their doorsteps, or refer patients to another facility if they don't have an ?emergency condition.?"

The law known as EMTALA requires only that a hospital emergency room get a patient to the point where s/he can move out the door. It is not unusual for patients with serious conditions to be discharged from ERs with no follow-up or appropriate medications, etc. Contrary to the News? assertion, non-residents can?t "demand care" unless they present with a true emergency.