Single-payer health care would save billions for Massachusetts
By David U. Himmelstein and Steffie Woolhandler
The
Boston Globe, May 30, 2012
The House and Senate health care proposals would set imaginary limits for
spending growth enforced by secret gimprovement plansh and wrist slaps for
hospitals that overcharge; establish tiered payment schemes to consign the poor
and middle class to second-tier hospitals and doctors; push most residents of
the Commonwealth into HMOs (oops, we forgot, now theyfre called gaccountable
care organizations,h or ACOs); and wipe out small doctorfs offices by gbundlingh
their pay into ACO payments. Apparently the legislatorsf theory is that forcing
health care providers to consolidate cuts costs. Oligopoly saves money?
Here are six alternative steps the Legislature could take that would actually
save money while still preserving care.
* Cut out the middlemen. Why exactly do we pay private insurers 10 cents of
every premium dollar? The plan that covers all 13 million residents of the
Canadian province of Ontario has overhead of only 1 percent. Adopting that
single-payer approach in Massachusetts would save about $2 billion in insurance
overhead in 2013 alone.
* Pay hospitals the way we pay fire departments: real global budgets that
cover all operating costs, not the per-patient schemes that are masquerading as
global payments. Billing, collections, and paperwork consume nearly one quarter
of hospitalsf revenues. Eliminate billing for individual patients and youfd cut
that nearly in half. The savings: about $3 billion in 2013.
* End the medical arms race and enforce real health planning. Hospitals and
clinics vie for affluent patients needing lucrative high-tech care. They reap
surpluses, a.k.a. profit, which they use to buy fancy machines and superluxe
buildings – usually situated where therefs already a surplus of such facilities.
Inevitably, the surplus facilities induce unnecessary, even harmful overcare.
Meanwhile, underserved communities and under-provided services like mental
health and substance abuse are starved of investment. Hospital payments should
go for patient care, not new buildings. Money for new buildings and technology
should flow to a separate fund, and be allocated according to need, not
profitability, through a transparent public process. Investing in whatfs needed
instead of whatfs profitable would save billions and improve care for both the
poor and the affluent.
* Right-size the physician work force: more primary care, fewer specialists.
Massachusetts hospitals take pride in training super-specialists who go on to
provide profitable but often unneeded care (see above). Meanwhile, the primary
care shortage persists. The public, through Medicare, already pays for residency
training and should use the power of the purse to make hospitals train the
doctors that the public needs. And physiciansf fee schedules should be altered
to assure that best students are attracted to the most needed, important, and
difficult fields – primary care – and that doctors make as much for talking to
patients as for putting them through a scanner.
* Negotiate drug prices statewide. Canadians pay 40 percent less for drugs
than we do because they use single-payer buying power to drive down prices from
pharmaceutical companies. Why canft we?
* Cap health executivesf incomes. Why should a hospital CEO make more than
the president of the United States?
David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
co-founded Physicians for a National Health Program. They are professors at the
City University School of New York School Public Health and visiting professors
at Harvard Medical School. They worked as primary care doctors in Massachusetts
from 1982-2010.
http://bostonglobe.com/opinion/2012/05/30/single-payer-health-care-would-save-billions-for-massachusetts/yNTLRlKucgdJCUCU3P5arM/story.html
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