As a past president of Physicians for a National Health Program, Dr. Oliver Fein thinks a single-payer health system for the United States would be superior to the Affordable Care Act, which he calls “a great leap sideways.”
“The problem is that the ACA fundamentally isn’t going to address some of the major challenges that face our health care system,” said Fein, a professor of clinical medicine and public health at the Weill Cornell Medical College in New York.
Fein will outline his ideas in Charlotte on Jan. 20 with a free talk – “Health Care Reform: ACA vs. Single Payer?” – for Health Care Justice North Carolina. The program is from 6 to 7:30 p.m. at Selwyn Avenue Presbyterian Church, 2929 Selwyn Ave. (Register by emailing HCJusticeNC@gmail.com.)
The first problem with the ACA is access, Fein said. While other industrialized countries provide health care for all citizens, the 2010 U.S. law doesn’t guarantee universal coverage. Some 30 million people will remain uninsured after full implementation.
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The other problem is “under-insurance.” Many who are insured through the ACA choose plans with low premiums. And those plans usually have high deductibles, co-pays and coinsurance. That can lead families to avoid using their insurance. If they do get sick, they may face out-of-pocket costs they can’t afford.
The third problem is cost. The ACA aims to hold down premiums by mandating most people to buy insurance, thus spreading the risk among both the healthy and the sick. But if penalties aren’t great enough to convince “young invincibles” to buy, the strategy won’t work.
Under single-payer, everybody gets care without confusing out-of-pocket expenses. And it saves money by reducing administrative costs.
Fein cited a comparison of Toronto General Hospital in single-payer Canada with Massachusetts General in Boston. “They have virtually three or four people dealing with billing up in Toronto,” Fein said, “and over 300 at the Mass General dealing with the multiple insurance companies.”
About 30 percent of the U.S. health care dollar is spent on administration, Fein said. That could be “cut in half” for a savings of $400 billion-$500 billion. “That money could be used to guarantee coverage without increasing the overall cost to the health care system.”
But is single-payer attainable in a country where many are wary of government control?
Probably not soon, he acknowledged. But over the next decade, he predicted the advantages will become clear.