The United States ought to implement a single-payer healthcare system

I already have acquesed to the notion that debating with a Libertarian will vindicate a certain degree of productivity if nothing else. The first portion of my case will explicate Bernie Sander's bill to bestow Americans with a single payer healthcare system. A single public entity, the federal government, would be responsible for collecting and distributing to the states all funds needed to pay for covered health care services in the United States. The annual health care budget could increase only as much as the gross domestic product. Each state would receive allocations based on the size and geographic distribution of its population, and on any special health needs. To allow for flexibility, states would administer the program. The state budgets would be divided into operating and capital expenses, with the share consumed by administration capped at 3 percent. Measures to improve the quality of care, described below, would reduce unneeded services and encourage the provision of more cost-efficient primary and preventive services. The General Accounting Office has estimated that by eliminating administrative waste and shifting the system's priorities, such a program would be well able to extend care to uninsured and underserved groups without additional expense. Administrative Simplicity Woolhandler and Himmelstein1 have estimated that 25 cents of every health care dollar now goes toward administrative expenses, including those of the nation's 1500 insurance companies. Differences in criteria for eligibility, covered benefits, underwriting procedures, and marketing costs within the insurance industry are in turn responsible for many of the administrative costs of hospitals, doctors, and other providers seeking reimbursement. Under the American Health Security Act, the federal government would collect the necessary funds -- a function it unquestionably performs effectively. A full-time seven-member national board, whose members would be appointed by the President for six-year terms, would oversee the program; the national board would be mirrored by a board in each state. There would also be federal and state advisory boards, as well as panels concerned with particular issues that need ongoing attention, such as standards of quality and benefits for mental health care and the treatment of substance abuse. All boards and panels would include both providers and consumers. Like many going concerns in America, in both the private and the public sectors, the health care system would come under the discipline of a budget. The American Health Security Act would tie increases in health care expenditures to the increase in the gross domestic product, which rose 2.1 percent in 1992, when health care costs rose about 9 percent. Health care institutions would have global annual budgets. States could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for-service basis according to a rate schedule. Balance billing would be prohibited. Universal Coverage Everyone would be covered under the same health insurance system with the same benefits, and there would be no duplicative insurance outside the system for covered benefits. Additional insurance would be permitted only for services that were not covered, such as elective cosmetic surgery. Reciprocity among states would be ensured. The link between employment and coverage would be broken. This is a critical feature of any reform -- to ensure security of coverage as our mobile population moves from job to job, to ensure that everyone receives the same quality of care, and to hold down administrative costs. It would take the increasingly contentious issue of health care benefits off the bargaining table and further assist businesses by relieving them of the administrative burdens of providing health care. States could choose whether or not to cover undocumented workers. Comprehensive Benefits In any health care system, what we pay for will determine what we get. Unlike many insurance plans, the American Health Security Program would cover a full range of primary and preventive care, as well as inpatient services and long-term care. Within the discipline of a global budget that limited unnecessary inpatient care, coverage for a broad range of services for mental illness and substance abuse would be affordable, along with services to coordinate care. The American Health Security Act would increase funds for training the personnel necessary to make these benefits accessible. The national board, guided by an Advisory Committee on Health Professional Education, would develop, coordinate, and promote policies and set goals for training more primary care physicians as well as midlevel practitioners and nonprofessional community health outreach workers. An initial goal would be to have 50 percent of medical residents in training programs in primary care within five years of the program's enactment. The act also addresses deficiencies in the health care infrastructure, which now prevent many low-income Americans from receiving timely and adequate care, through increased funding for community and rural health centers, for the National Health Service Corps, and for many other important but currently underfunded public health services. Quality Assurance Many useful criticisms have been made of aspects of the current quality of health care, ranging from the adequacy of information available to providers to providers' responsiveness to consumers' concerns. In response, changes have been made in the training curriculum for health professionals and sophisticated data-collection systems have evolved to begin to meet those challenges. In the long run, the most important improvement this proposal would make in the quality of care would be to remove the perverse financial incentives that distort medical practice today. However, even the experience in Canada, which has drastically altered those incentives, indicates that in the interim there is a need for careful attention to evaluating and improving the quality of medical practice. The critical issues are the extent to which practitioners are integrally involved in creating and enforcing their own standards, and the extent to which better clinical management is assumed to be a function of economic forces, as opposed to a conscious effort by practitioners and consumers. The American Health Security Act proposes a publicly accountable system that would be highly sensitive to the views of providers and patients about quality. A national Quality Council would develop and disseminate practice guidelines based on outcomes research and would profile health care professionals' patterns of practice to identify outliers. A national data base would facilitate both the portability of patient records and research on outcomes. In determining the need for and the nature of ongoing benefits for chronic conditions, a combination of services to coordinate care and utilization review may be desirable. In such cases, regulations would require peer review by equivalent professionals, financial independence for reviewers, timely decisions, and an appeals process. The board would develop incentives to encourage the appropriate use of centers of excellence, defined as tertiary care centers that could meet standards for the frequency of performing procedures and the intensity of support mechanisms that are consistent with the high probability of desirable patient outcomes. The Quality Council would develop guidelines for certain medical procedures designated by the board to be performed at these centers. The emphasis on primary and preventive care would encourage the maintenance of health and the early diagnosis of illness. The act would require states to develop incentives for multidisciplinary care, a key to high quality in the most successful group practices. State plans would have to include a procedure for regional management and planning functions that would address the maldistribution of health personnel and facilities. Each state's procedures would also have to encourage needs assessments and community-oriented primary care, with integration of public health epidemiologic data into the delivery of care. The plan would discourage the overuse of procedures that may be both unnecessary and harmful. Equitable Financing The single-payer system would replace private premiums with public premiums. Instead of insurance plans that charge individual people and businesses the same amount regardless of income or profits, the public plan would be progressively financed by increases in the top marginal income-tax rates for individuals and corporations, payroll taxes on employers, and a premium equivalent to the Medicare Part B premium to be paid by those over 65 years of age, as well as by closing a variety of tax loopholes. The vast majority of people and businesses would pay far less for health care than they do now. These savings would in part offset the increase in taxes, and some of the savings to business would be available to employees as wage increases. In return, every American would receive the security of comprehensive health care services for life, services that would be available whenever they were needed. Bill provided by http://www.nejm.org...