Case for Single Payer Health Care

[Guest guest]

The New Republic

The Treatment (TNR's health care blog)

April 17, 2009

TNRtv: The Case for Single-Payer Health Care

By Cohn

At the 2009 World Health Care Congress, TNR senior editor

Cohn sat down with Dr. Chen, Vice President and CFO of

Taiwan's National Health Insurance Bureau, to discuss the results of

Taiwan's switch to a universal health care system.

Cohn (JC): You have what most people refer to as single payer

health insurance - the government is the main insurer for everybody.

Dr. Chen (MC): Yes.

JC: How did you decide on that model - the single payer? Why did you

go in that direction?

MC: Well, we sent our people around the world to learn their programs,

including the United States. Actually, the program is modeled after

Medicare. And there are so many similarities - other than that our

program covers all of the population, and Medicare covers only the

elderly. It seems the way to go to have social insurance...

JC: Now, one issue that comes up in the United States when people talk

about a single payer system, or even any kind of a system where the

government is defining the benefits, there's a big concern that

there's not enough choice. People in America... we want to know that

you can choose the kind of insurance you want - how much coverage,

what services. Is that an issue you dealt with in Taiwan? Was that a

concern?

MC: Not at all, because in Taiwan the benefit package is rather

comprehensive... We maintain a very long list for prescription drugs -

more than twenty thousand items. And the benefit package includes

inpatient, outpatient, and dental service which is usually not covered

in this country.

JC: Now the flip side is that if you are offering such a generous

package, that's very expensive, is it not? I mean, how do you pay for

it?

MC: Not the case.

JC: Not the case. What percentage of GDP?

MC: Six percent of GDP, so that's very affordable. The premium on

average that the family pays is about two percent of the household

income because the premium is shared by your employer.

JC: ... In this country we spend far more than that, and even looking

at Europe - Switzerland, France - they spend a lot more than that

also. Are there waiting times for services in Taiwan? Is there

something that people are going without? I mean that's a lot of

services for such a little amount of money. I'm trying to figure out

what it is that you're not getting.

MC: No waiting lines.

JC: No waiting lines? I can see a doctor any day I want...

MC: If you are not too particular.. you can visit even a specialist in

a matter of minutes...

***

JC: ... If I were to be sitting here with a doctor in private practice

in Taiwan - I know in this country doctors worry a lot that Medicare

doesn't pay enough money and that it's very bureaucratic - what kind

of complaints would I hear from them?

MC: Of course, doctors would complain in public, but appreciate it in

private - because, you know, especially in this economic downturn, how

can you find an industry with assured growth rate annually? Right now

they enjoy somewhere between four percent to five percent increased

rate, and this is a sure thing.

Comment: Our political leaders keep telling us that Americans don't

want single payer, but instead we want a uniquely American solution

for all Americans.

So what did Taiwan do? They looked at health care systems throughout

the world, and they chose a uniquely American system for Taiwan! -

Medicare! - except that they expanded its benefits and included

everyone. And it really works well.

So Congress is returning from recess with health care reform at the

top of its agenda. They have already decided that single payer is off

the table, but they are having difficulty in addressing three issues:

1) the role of government in regulating the private insurance industry

and offering a public insurance option, 2) the near impossibility of

covering everyone in the fragmented, multi-payer system that they have

selected, and 3) the difficulty in finding funds to pay for this model

of reform - the most expensive ever devised.

But they've taken off the table the one model that would work - the

uniquely American program: Medicare for All. Fixing Medicare and

providing it for everyone would: 1) define the most effective and

efficient role that government could have in health care financing, 2)

make coverage completely automatic for absolutely everyone, and 3)

reduce inefficiencies and waste that would eliminate the need to

search for other funds.

Oh wait... There is that uniquely American industry that helped pay

for the elections of our members of Congress: the private insurance

industry (no relation to the social insurance private plans of other

nations).

What a difficult decision for Congress: taxpayer dollars to support a

uniquely American private insurance industry that remains incapable of

ensuring affordable health care for all, or efficient financing of a

uniquely American Medicare for All that would provide for the health

care needs of everyone.

Actually, for Congress that decision is not so difficult. Medicare for

All is already off the table.