COMMENTARY
Single-payer system can cover healthcare for all
By Renee Ing
Recent reports on a preliminary study by a healthcare consulting group hired to "crunch the numbers" for a single-payer healthcare system covering every Hawai'i resident should be read by anyone concerned about healthcare costs in this state.
Mindful that their "model is still being refined," this report also needs to be put into a broader context.
Polls consistently show that 65 percent to 85 percent of Americans have wanted for decades for the U.S. to have universal healthcare covering everyone as other developed nations do, and for many good reasons.
Preventive medicine as an important cost containment strategy is possible in a universal system. Healthcare in other countries allows everyone to go to doctors of their choice and have quality care costing them half of what Americans pay.
Illnesses are prevented, monitored and rehabilitated — or at work, people are retrained for another job. Care includes doctors and nurses doing home visits, to follow up on hospitalizations.
If Hawai'i switched to a single-payer system, an Advertiser article said, "the state would take control over healthcare (and) the state would offer a single benefits plan through contracts with healthcare providers."
In fact, the doctors and hospitals (Kaiser, etc.) would still give us our healthcare, as they do now. The state would only handle collecting the healthcare premiums and paying healthcare providers.
Single payer is simply a financing system.
The Hawai'i system studied would not be similar to Canada's single-payer, which covers more than Kaiser and HMSA do (i.e., home visits, etc) and is more like the old Medicare.
Nor is it like Great Britain's system, which is more like the Veterans Administration.
The system studied is one where the whole state of Hawai'i would adopt a version of the state's civil service health plan (mostly provided by Kaiser and HMSA). Health coverage would be better than what is now given to half the working people in Hawai'i who get health benefits under the Prepaid Health Care Act, which requires companies to offer insurance to people who work more than 20 hours a week.
When the consultants were hired, they were asked to assume a few points:
A universal health system has two major outcomes:
The consultant has been asked to look at the model again, to address problems in the first draft that did not conform to these expectations.
There are a few problems.
Some blame technology for the rampant escalation of healthcare costs, but a deeper look shows a lot of duplicative over-capacity waste — where technology is acquired by every facility to keep up with competitors, even if they may not have enough need for that new technology.
Also of relevance, effective technology nearly always gives cost-cutting gains over previous technology, but as technology is standardized and mass produced, costs invariably should drop — unless monopoly pricing conditions exist.
A main thrust of universal health systems is to save money.
As the report says, "the expected savings would come mostly from lowering administrative costs and from bulk purchases." Savings should be much greater in a single-payer with only one administrative bureaucracy to support.
Healthcare costs under the current system, with its problems and waste, have doubled in the last decade.
The costs are predicted to double again in the upcoming decade.
This makes it very important to bring everyone in Hawai'i under a single-payer system to get rid of the many duplicative, expensive administrative bureaucracies and costs.
Single-payer systems have other cost containment capabilities that our current health system doesn't have. With all healthcare revenue put under one fund, single-payer systems can then parcel out healthcare dollars to all healthcare players, according to past expenses and projected trends — giving them "global budgets" for the coming year.
Medical providers are expected to stay within budget. This is in contrast to our current system where some medical providers try to maximize their income, driving the cost of healthcare higher and higher.
Let's make Hawai'i the "Health State" again, and continue to lead the nation in forward-looking social policy.
