Fwd: qotd: Senate committee on single payer lessons for the U.S.

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-------- Original Message --------
Subject: qotd: Senate committee on single payer lessons for the U.S.
Date: Wed, 12 Mar 2014 13:15:49 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



United States Senate
Committee on Health, Education, Labor and Pensions (HELP)
Subcommittee on Primary Health and Aging
Chaired by Sen. Bernard Sanders
March 11, 2014
Subcommittee Hearing - Access and Cost: What the US Health Care System
Can Learn from Other Countries

Statement by
Tsung-Mei Cheng, LL.B., M.A.
Health Policy Research Analyst
Woodrow Wilson School of Public and International Affairs, Princeton
University

Today's hearing is focused on "international single payer health system
models that provide universal coverage of health care." I will tailor my
remarks according to the three sub-themes the Committee wishes to
explore, namely:

* Primary care access in single payer systems
* Health care costs in single payer systems, and
* Cross-country comparisons of health outcomes

Before proceeding with the Committee's agenda in more detail, however, I
would like to provide the Committee with a summary of my main points:

1. If equity and social solidarity in access to health care and
financing health care were fundamental goals of a health care system,
the single payer system provides an ideal platform for achieving these
goals.

2. Single-payer systems typically are financed by general- or payroll
taxes in a way that tailors the individual's or family's contribution to
health-care financing to their ability to pay, rather than to their
health status, which until this year has long been the practice in the
individual health insurance market in the U.S.

3. These systems protect individual households from financial ruin due
to medical bills.

4. Single-payer health systems typically afford patients free choice of
health-care provider, albeit at the expense of not having a freedom of
choice among different health insurers. Remarkably, in the U.S.
households have some freedom of choice of health insurers – to the
extent their employer offers them choice – but most Americans are
confined to networks of providers for their insurance policy. In other
words, Americans appear to have traded freedom of choice among providers
for the sake of choice among insurers.

5. In single-payer systems "money follows the patient." Therefore
providers of health care must and do compete for patients on the basis
of quality and patient satisfaction, but not price.

6. In a single payer health insurance system, health insurance is fully
portable from job to job and into unemployment status and retirement.
The "job-lock" phenomenon prevalent in the US is unknown in those
systems, contributing to labor-market efficiency.

7. Because all funds to providers of health care in a single-payer
system flow from one payer, it is relatively easy to control total
health spending in such systems. Indeed, total national health spending
as a percent of GDP in countries with single-payer systems is lower than
it tends to be in non-single-payer health systems. This does not mean
providers are left without a voice. Provider inputs are part of the
formal negotiations over health-care budgets.

8. For the most part, single-payer systems achieve their cost control by
virtue of the monopsonistic market power they enjoy vis a vis providers
of health care. It is a countervailing power that the highly fragmented
U.S. health-insurance system lacks vis a vis providers.

9. As part of their effort to control total health spending, however,
and to avoid the waste of excess capacity that easily develops in health
care, some single-payer systems (the UK and Canada) put constraints on
the physical capacity of their health system (number of inpatients beds,
MRI scanners, etc). That approach can lead to rationing by the queue.
The alternative to rationing by such administrative devices, of course,
is rationing by price and ability to pay, an approach used by design or
by default in the United States. Rationing by price or by non-price
mechanism are just alternative forms of rationing.

10. A single-payer system is an ideal platform for a uniform electronic
health information system of the sort, for example, used by our Veterans
Administration health system (a single-payer system in its own right).
There is a common nomenclature which enables 100% electronic billing and
claims processing, thus yielding significant savings in administrative
costs.

11. Because they conveniently capture information on all health-care
transactions, single-payer systems provide a data base that can be used
for quality measurement, monitoring and improvement, and also for more
basic research on what drives health spending and what clinical
treatments works and does not work in health care. It enables evidence
based medicine and the tracking of efficacy and safety of new drugs and
devices once they are introduced after approval by government based on
results of clinical trials.

Statement of Tsung-Mei Cheng (28 pages):
http://www.help.senate.gov/imo/media/doc/Cheng.pdf

Video of the hearing and links to statements of all participants:
http://www.help.senate.gov//hearings/hearing/?id=8acab996-5056-a032-522e-e39ca45fcfbe

****


Comment by Don McCanne

Sen. Bernie Sanders chaired a Senate committee hearing on what the
health care system in the United States can learn from other countries.
Tsung-Mei Cheng provided an excellent overview of single payer and of
the sharp contrasts between the United States and other nations. Her 28
page statement is well worth downloading to use as an information
resource in educating others about single payer.

Other informative presentations included those of Victor Rodwin on
France, Ching-Chuan Yeh on Taiwan, Danielle Martin on Canada, and Jakob
Kjellberg on Denmark. Even the presentations from the other side by
Sally Pipes and David Hogberg were helpful in that they showed how silly
(sadly) their views were when contrasted with a group of experts who
understand well how systems based on solidarity work. If you can find
the time, viewing the entire video (1 hour & 46 minutes) and reading the
statements would be well worth the effort (link above).

If you don't have the time, at least view this 4 minute YouTube video of
clips from the hearing:
https://www.youtube.com/watch?v=9WdqtPLRc1A