Michael Moore's new documentary Sicko has renewed debate on single-payer health coverage in the U.S. It has been suggested by Bay Area Reporter columnist Dale Carpenter that "government-run health care" would be a bad deal for the LGBTI community. These arguments often rely on unfounded fears and disinformation, so let's start with some facts:
According to researchers from Harvard Medical School, government already pays 60 percent of the health care bill in the United States. Our system of private insurance systematically dumps the sickest patients onto public resources. Most of the very sick end up on public health benefits, including Medicare and Medicaid (MediCal in California), sooner or later. As for the private health care dollar, nearly one-third goes to a combination of corporate profits, executive compensation, advertising, and systems designed to deny care to the sick.
The social costs of the inefficiency of the private system are staggering. Health care expenses are the leading cause of personal bankruptcy in the United States. High costs to employers lead to layoffs, depressed wages, and loss of other benefits. Forty million Americans are uninsured. They either go without care, rely on a limited supply of charity care, or turn up in public hospitals and clinics. Often, they're sicker than they might have been if they had earlier access to care, and they can't afford the care or medications that could make them well.
Those who oppose single-payer insurance sometimes attempt to raise fears that private pharmaceutical research and development would stop. They imply that most R&D comes from the private sector. But the Congressional Budget Office stated, "It is seldom possible to identify particular cases where private industry would have performed research where the government had not." It's hard to argue that the current system is promoting private R&D. Private R&D, though still important, has actually decreased as a percentage of sales in recent years.
Medicare Part D is a new publicly-financed but privately-administered program to provide prescription coverage to Medicare patients. Much of the funding for Part D is diverted into a remarkably arcane multi-insurer system. Patients and doctors find it nearly impossible to keep up with what is covered under which plans, and it constantly changes. It is the multi-insurer aspect of Part D that makes it so difficult to maneuver through.
Here in California, we're fortunate to have all HIV drugs covered under public benefit programs, but in many parts of the country, people with HIV can't get the drugs they need. Even though California covers HIV medications, the bureaucratic requirements of our fragmented system add dollar costs to the final bill, in addition to creating barriers to patients. More than once, I have patients tell me they couldn't get their HIV medications, because they couldn't get through the bureaucratic requirements for coverage. This situation repeats across the country, and for all kinds of medical diagnoses.
With a single-payer plan such as the one that lesbian state Senator Sheila Kuehl (D-Santa Monica) has proposed (SB840), we could immediately remove these bureaucratic roadblocks to coverage. We could also regulate the costs of medicines, so that private companies are ensured of an acceptable return on investment, and the public gets the benefits of medications our tax dollars help develop.
This debate is not about "state-run health care," as some suggest. It is really over who pays, and who gets the money. The private insurance system wastes money that could be used better. Any additional tax burdens, especially if progressively distributed, would be more than offset by savings. Around the industrialized world, single-payer systems result in greater efficiency and better health outcomes. In these systems, you – not your HMO or insurance company – choose your doctor, your hospital, and your treatment. In the best systems, competition based on quality and patient satisfaction drives the system at the service level, which is why more people in Canada and France than the U.S. say they're satisfied with their care.
Finally, consider this: Canada, Britain, France, and many other countries that have single-payer systems, have more enlightened attitudes on homosexuality than the U.S. Arguably, this isn't a coincidence. Political systems that guarantee provision of the basic needs of citizens tend to be more socially accepting of difference. By contrast, when political systems create economic inequality and widespread insecurity around basic needs, politicians have a powerful incentive to change the subject. Demonizing a minority is an age-old tactic for politicians to deflect attention from their political failures. The political failure of our health insurance system can be rectified, to the benefit of everyone.
Dr. Paul Quick is board certified in internal medicine. He is also certified as an HIV specialist by the American Academy of HIV Medicine. He practices medicine at Tom Waddell Health Center.