One of the topics that may come up during SPR’s upcoming health forum is the possibility of a single-payer health care system, such as what Canada and other industrialized nations use. The concept has been raised many times, including by Bernie Sanders during the 2016 presidential campaign.
A bill that would have introduced a single-payer system called Healthy Washington was introduced during this year’s session.
“I’m Sally Soriano with United for Single Payer and a former Seattle School Board member. Thank you for holding this important, timely hearing," Soriano began her testimony.
"Last June, a national Pew poll found that 60% of the American people favor a Medicare-for-all single payer health care system," she said. "At the heart of the problem is a market-based system that treats health care as a commodity, one in which executives and shareholders literally make money by denying care to those who need it. This legislation, Healthy Washington, would provide health care for all Washington residents. A public good; comprehensive, affordable, high quality, publicly-financed, seamless, in an equitable manner, regardless of income and assets.”
The bill never left the committee and Soriano was the only member of the public to testify for it. But she’s not the only person in Washington who is thinking single-payer.
Last November we brought four proponents of it into our studio. One was Denny Dellwo, a former Democratic state representative from Spokane who, during the early 1990s, chaired the House Health Care Committee. Those were the days when the Clinton Administration was talking about overhauling the health care system and Dellwo was a big player in discussions at the state level. Twenty-five years later, he has become a single-payer proponent.
“One of the main moving factors was the belief that health care should be a right instead of just something you were able to buy. Right now, under the law of the state of Washington and the United States, there is not a clear indication, certainly a legislative indication, that it is a right. The constitution, we believe, provides for that, but it has not been articulated in the legislature as it should be," Dellwo said.
"What we’re trying to do here is have a single-payer system developed that would be able to do what every other Western nation in the world has and that is, have a single-payer system that provides the health care as a right to the people who live in the country,” he said.
“Here in the United States, if you get sick, you do not have insurance, you go bankrupt. You get poor. It’s not like that in other countries," Spokane registered nurse Lynnette Vehrs said. "The other thing is 120 people a day that do not have health care insurance die, in the United States. And that shouldn’t be like that either. It’s the insurance companies here in the United States that are rationing the care.”
Retired physician Dan Schaffer became a single-payer proponent after years of navigating the current insurance-based system. Schaefer co-owned First Care Med Center in Spokane, which was later bought and renamed the Rockwood Urgent Care Centers.
“We had the misfortune of having to deal with billing with insurance companies on a regular basis and seeing our accounts receivable go our 45-to-60 days on an average before we’d get paid for any of the visits. And then, even though we’d bill for a specific amount, it was never quite certain what we’d actually get paid because each insurance company had different rules and regulations," Schaffer said. "We had an entire section of our office staff that did nothing but deal with the insurance companies and bill insurance companies.”
How is a single-payer system financed?
"It’s paid for through some type of general revenue-generating mechanism. That is through, probably, that nasty old word ’tax,’ but if you say that it’s a tax, what it does is replace premiums," he said. "So you could actually call it a health care premium, instead of a tax, that everybody pays and maybe that will fly better than the word tax."
That general tax is how Medicare is funded, for the most part. Schaffer argues a Medicare-for-all system would be less expensive and more efficient.
“There are no shareholders that have to be paid. The administrators are not making seven-figure incomes and it’s a single-billing system so they don’t have to deal with a number of different forms. The forms are the same and so there is more efficiency in the fact that it is a top-down system that is organized to be efficient," Schaffer said. "It’s a transparent organization because it’s a publicly-funded organization so the figures are available to the public to check and so there’s accountability.”
And who would run a single-payer system? Cris Currie, a local registered nurse and single-payer advocate, says it would have to be a non-profit organization.
“It could be a mixture of private and government," Currie said. "The easiest way to do it is just tag on to our existing CMS, the Center for Medicare and Medicaid Services, which is already set up, which is also doing a reasonably good job. The system in both of the federal bills call for an improved Medicare system, so we’re not saying Medicare-for-all means Medicare exactly as it is now for all. Several areas definitely need to be improved.
"Right now, Medicare is administered by private companies, the Blue Cross and Blue Shield companies, and that was done when Medicare was first enacted in 1965 to appease a lot of people who just didn’t trust the government. So they say we’ll farm it out to, most of the administration out to, private companies and the Blues pretty much got it and are still basically running it," Currie said. "But even so, with that subcontracting, the overhead for Medicare is still around three-percent at the most, which is far lower than any other, because they don’t have the marketing costs, they don’t have the administration of approving and denying claims that insurance companies do. The lobbying expenses that private insurance companies have. That would all be eliminated.”
“The confusion is people think this is a government takeover, when in fact it’s only the financing of it," Denny Dellwo said. "The doctors, the hospitals, all the medical providers are still independent. You get to keep your doctor. You can get whatever health program you want to get involved in. You just show your card to whatever place you go and you’re covered. That’s the system that is under a single-payer system. In Canada, all the doctors are independent. The hospitals are independent. And their record-keeping and billing is all just so much simpler because it is a unified system.”