Jeff Kane: Continuing the dialog on single-payer national insurance | TheUnion.com

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Jeff Kane: Continuing the dialog on single-payer national insurance

I'm glad my commentary regarding single-payer health insurance generated such dialog. Thanks to Mr. Krosner and Mr. Ulery for raising important points, especially around the themes of cost, choice, control and "rationing."

Cost. Contrary to much popular belief, the government does not set the cost of health insurance. Obamacare leaves that to the insurance companies. If you don't like the price hikes, write a letter to your company.

Everyone agrees that healthcare is insanely expensive and getting more so. In fact, that's happening under every system. For example, Mr. Ulery is right about the British National Health Service hitting the skids. Sir Bruce Keogh, medical director of the NHS, recently warned that the service will be sustainable only if it moves away from reliance on hospitals and toward family practice, and integrates services better. That doesn't mean the NHS is a failure, only that it's spotting and addressing problems. Any system the United States adopts will have to face the same issues.

A significant chunk of Obamacare's cost is the operating expense of private insurance companies. The Congressional Budget Office has found that Medicare's administrative costs are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans. Another recent report from the General Accounting Office found that in 2006 private Medicare Advantage plans spent 83.3 percent of their revenue on medical expenses, with 10.1 percent going to non-medical expenses and 6.6 percent to profits — a 16.7 percent administrative share. In other words, it seems clear that Medicare patients get significantly more healthcare for their insurance dollar than patients with private insurance.

Choice. I go sour, too, when I think of the government forcing us to buy health insurance. But we know we need it anyway, since with a single auto accident, there goes the home. There's hardly any choice to not buy, then, but we'll be darned if we'll buy by government edict. A single-payer system would delete another choice, too, the freedom to shop for private health insurance, with its myriad of confusing differences in coverage and exclusions, proprietary paperwork, accessibility, competence and ethical history.

Control. A national single-payer system wouldn't control medical practice, only pay for it. Only pay for it, not run it. Some medical programs — like the VA and all of military medicine — are indeed government-owned-and-run, but single-payer would only pay. No one's suggesting eliminating the private sector, just recognizing that sometimes — consider fire and police protection, roads and national defense — government does a decent job.

"Rationing." Not everyone will get everything. Whether you're Medicare, Aetna, or your own agent, if you don't set limits on what you'll pay for, you'll go promptly belly-up. If there were no insurance in the world, you'd need to decide whether or not to afford medical treatment; is that rationing? When your insurance says the drug you need isn't covered because it's in Tier III, schedule K, is that rationing?

Certainly there's more to discuss, as many healthcare reform issues haven't yet seen enough light of day.

Hopefully The Union's editorial page will remain an ongoing venue for dialog.

Jeff Kane, MD lives in Nevada City.