Jun 13, 2009

Single-payer Health Insurance Demystified

My amazing, French friend, Suzanne White, writes this essay to help Americans conceptualize single-payer health insurance. As usual, she cuts right to the heart of the matter--we tend to shy away from that which we don't understand.

Here single-payer health insurance is in simple terms. I get it now. I like it. And I think it's the only fair way to go. Some mighty big organizations--the AMA, pharmaceuticals, not to name any names--are gonna bust their butts to fight this plan--just the way the car companies once fought public transportation. But let's make sure companies do not control our lives. Please.



IT HAS COME TO MY ATTENTON that many Americans do not understand what SINGLE PAYER HEALTH INSURANCE is.

Not understanding something can cause one to fear it.

I notice some Americans faces go blank when I mention Single Payer. But rather than ask what it means or trying to find out, they resist the very idea and sputter defensive words like "socialism" and "government control". That's too bad. The US government is not trying to inflict something on the American people by adopting single payer. It's only trying to help them get full coverage for a modest premium.

I will try to explain here how it works for me in France. Please read ahead. See how it works and then draw your conclusions about whether or not you want something like this in the U.S.

Single Payer Health Insurance is (with variations) a system wherein the govt owns a health insurance company. Not the ONLY health insurance company. There are many private carriers as well.

In France, just about everybody chooses the national company because the premiums are based on their incomes. Employers pay a % of our income (publishers, film productions,dance companies as well as businesses) so that everybody is covered. We pay premiums ( a % of what we make) to the govt company every month or, maybe every trimester. But health insurance does not come out of our taxes. Premiums are, in fact, tax deductible.

So everyone pays something different based on his or her family situation (many kids or handicapped etc. would probably pay less) and income. But... everyone is equally covered.

The care one receives is not based on the amount he or she pays in. But rather care is based on how ill one is. There are 19 or 20 major diseases (cancer, diabetes, MS etc) which guarantee 100% coverage for everything to do with that illness so long as you have it. Otherwise, in most cases, there is what Americans call a co-pay. The govt company may pay 80% of the 20 Euro doctor visit. But we pay the extra 20% out of pocket.

The basic difference in feeling when you live in a place with Single Payer is that you don't live in fear of yourself or your children or your family members falling ill. If they get sick, they get care. The sicker they are, the more they get cared for.

Logically, when there is a govt health insurance company whose job it is to keep people healthy, the govt spends lots on encouraging preventive health care. Commercials on TV and ads in the M├ętro and buses give advice and the phone numbers of free clinics to stop smoking and curb alcohol abuse etc.

Naturally too, when a government owns a health insurance company, it wants to save money. How does it save money? By keeping the people healthy. Disallow genetically modified foods. Fewer pesticides and fewer chemicals in the prepared foods and indeed fewer prepared foods. Ads about exercise and ads about careful driving etc abound. The govt also control prices on medicines. Nowhere is medicine cheaper than in France. The pharmaceutical companies don't like this practice. But it's obliged to accept it. One cannot advertise prescription medication on TV. Only alternatives or homeopathic (comfort) medicines which can be bought over the counter are allowed to be advertised.

Lastly, private insurance companies compete with the govt company. Their first job is to absorb the rich people who don't want to join the national company because paying a % of their income would be too dear. So rich people often buy private coverage. Secondly, private insurers serve as co-payers. If you have both public and a small private additional policy, the latter will pay the co-pay and sometimes dental and eye care too. ( The govt plan pays only a minimum for dental and eye care) .

What Obama meant when he said he wanted a govt company to compete with private insurers in order to keep the private insurers honest, he meant that if the myriad private insurers in the U.S. had to compete with a govt health plan which covers everything for a % of income, the private companies would have to offer more coverage for less money. That's what he means when he says single payer keeps private companies "honest".

Compare it to the BBC competing with Private TV in England. The BBC is free and without commercials and, as we know, has wonderful programs for all sectors of society. The BBC's excellence keeps the private TV stations on their toes. They too have to make great documentaries, offer hilarious sitcoms and dramas and give great news coverage too - or else the Brits will prefer the BBC.

It's a sound policy and it works.

Is it in debt? Yes. Constantly. But I ask you, would you prefer your government to be in debt from spending too much on TV or health care? Or would you prefer the government be in debt from overspending on wars and bank bailouts?

By Suzanne White

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