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Why Employer-Based Health Insurance Doesn't Cut It

The majority of doctors believe a single-payer system would provide the best care.

In December, President-elect Barack Obama invited Americans to hold more than 4,000 "health care house parties" and discuss medical reform.

Laura Boylan, a New York City neurologist, hosted one such meeting in the living room of her family's apartment on Dec. 15.

"The questions they asked us to distribute to attendees didn't address the single-payer issue, but instead presumed that employer-based and private insurance would continue to take precedence," says Boylan, a local board member of the Chicago-based Physicians for a National Health Program.

Despite a fierce insurance lobby and an incoming administration pointed in another policy direction, Boylan and her 11 guests -- all doctors, nurses or health activists -- agreed they were prepared to back legislation to create a single-payer system, in which a publicly financed entity (a "single payer") reimburses providers for their services instead of having private insurers reimburse for these services, as they do now.

In 2006, California lawmakers approved a single-payer system in their state. Gov. Arnold Schwarzenegger vetoed it, claiming "socialized medicine is not the solution to our health care problems."

Despite this kind of philosophical aversion to their favored approach, Boylan and her allies note that the single-payer paradigm is succeeding in Canada and Europe and has majority support among physicians and citizens here.

A 2004 Archives of Internal Medicine survey showed 63 percent of doctors believe a single-payer system would provide the best care for the most people. A 2007 CNN poll showed 64 percent of Americans believe "the government should provide a national health insurance program for all Americans even if this would require higher taxes."

Obama's Stopgap Pledge

During his campaign, Obama pledged to preserve the employer-based private insurance system and create a stopgap federal program to cover the uninsured.

He is also expected to give serious consideration to a proposal by Senate Finance Committee chair Max Baucus, D-Mont., for mandatory insurance with private companies competing alongside a new Medicare-type program.

For advocates such as Boylan, legislative leadership is coming from Rep. John Conyers Jr., D-Mich., who in 2003 and 2007 introduced the National Health Insurance Act (HR 676) to create a publicly financed single-payer system.

"With 47 million Americans uninsured and 50 million underinsured, it's past time for change," Conyers recently told Women's eNews through a spokesperson.

Supporters of a single-payer system propose two possible funding methods. One would be a 3.3 percent payroll tax and a reversal of President Bush's tax cuts for the wealthy. Another would be to rely on payroll taxes of 8.17 percent for employers and 3.78 percent for employees. Advocates say that, despite additional taxes, a single-payer system would save citizens money.

Conyers' bill has been endorsed by only 93 of 535 members of Congress. Fourteen national labor groups and 20 health and civic groups, including the National Organization for Women and the Coalition of Labor Union Women, both in Washington, have lined up behind it. With Obama slated to take office in nine days, Conyers has pledged to hold hearings on his proposal in the House Committee on the Judiciary, which he chairs.

Geri Jenkins, co-president of the Oakland-based California Nurses Association, says the guaranteed health insurance of a single-payer approach is necessary when so many people are losing their jobs. "Unemployment recently surged to 7.2 percent, and for every 1 percent increase in that rate, 1 million more Americans are predicted to lose their health insurance coverage," Jenkins says.

Industry Opposition

The Washington-based America's Health Insurance Plans, an insurance trade group, argues a single-payer system could result in lower payments for health care providers and job loss in the health care industry, which employs 12 percent of U.S. workers. Of those 12 million workers, 80 percent are women, reports the National Institute for Occupational Safety and Health.

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