NEWS

A single-payer system for Massachusetts – The time has come
By John V. Walsh, MD
John Walsh is professor of physiology, biochemistry and molecular pharmacology at the University of Massachusetts Medical School. He is a member of Physicians for A National Health Program and twice ran for U.S. Congress on a single-payer platform. He says he lost each time “by exactly one million dollars.”

The United States spends over $4200 annually for each and every man, woman and child on health care, and yet we leave over 44 million Americans without health insurance and one quarter of our population underinsured. (The expenditures here in Massachusetts are even greater, over $5000 per capita, and yet we leave between 400,000 and 600,000 without health insurance out of a population of 7 million.) In contrast Canada spends about $2200 per capita, insures its entire population and guarantees everyone his or her choice of doctor and hospital. Moreover, Canadians live an average of two years longer, have lower infant and maternal mortality rates and are generally healthier than we are. Most startling is that the U.S. now spends over $2500 per capita for health care out of public funds, more than Canada spends in toto on health care. 

Clearly our neighbors to the north are doing something right. But the facts about their system are rarely heard and no assertion about it is too wild to see newsprint these days – thanks to the vested interests opposed to genuine health care reform. So how does Canada’s system work?

From the point of view of the average Canadian, the system amounts to a card – in appearance much like a driver’s license – issued to each and every citizen. A Canadian simply presents this card to the doctor or hospital of his or her choice, and the government pays the bills. It’s as simple as that. Everyone, rich or poor, employed or unemployed, gets the medical attention they deserve. 

The question of waits

Are the anecdotal accounts about long delays, so favored by right wing pundits, in fact true? In a poll reported some years ago the by The New York Times, virtually every Canadian polled said they get whatever health care they need within 24 hours! And the care is every bit as high tech as in the U.S. For example, there are the same number of organ transplants in Canada per capita as in the U. S. It is true that for some elective procedures, for example, knee replacements, the wait is a few weeks longer on average than in the U.S. (Of course those in the U.S. without insurance will have no wait since they cannot get the surgery at all.) But for other illnesses, the waits are shorter. For example, if a woman detects a lump in her breast, she will be diagnosed more quickly in Canada than in the U.S.; and if a malignancy is detected, surgery will be done sooner! When Canada adopted its universal, single-payer system, care shifted toward the more urgent and serious illnesses. That’s because decisions are made by health care professionals on the basis of the need for care and not by bureaucrats on the basis of ability to pay and the desire to maximize profit.

Canadian pride in their system of health care

Despite some imperfections in their system, Canadians are justifiably proud of it and very protective of it. No politician, no matter how conservative, will openly suggest doing away with it. Canadians have been polled over and over again on how they like their system in comparison to ours. When asked whether they prefer their system to ours, 95% said they prefer the Canadian system. That is a remarkable level of agreement, and all the more remarkable since Canada had a system like ours until the 1970’s. Canadians have experienced both systems, and clearly they have no desire to turn back the clock to a health care system like ours!

National Health Insurance

How do the Canadians do all this at a per capita cost that is 50% of what we spend in Massachusetts? The secret lies in what is called a single-payer system. In contrast to a country like Great Britain, Canada does not have a system of socialized medicine in which the government owns and operates the health care system. Instead Canada has national health insurance. There are no insurance companies or HMOs with their vast and expensive bureaucracies designed to deny care and harass health professionals, with their enormous profits and with scandalous CEO compensations. In Canada the government insures everyone. It is not socialized medicine but socialized insurance. It is a compromise between unrestrained market forces and government ownership - a golden mean if you will. In sum the government is the sole insurer for private, competitive care, but the competition is based on quality not price.

The single-payer arrangement immediately results in great savings by eliminating the suffocating glut of red tape and bureaucracy of a multi-payer (i.e., many insurance companies), HMO-dominated system like our own. Each year we in the U.S. spend 25 cents of every health care dollar on administrative overhead whereas the Canadians spend 10 cents. That is 13 cents difference on each of the more than one trillion dollars spent on health care in the U.S. each year – or about 130 billion dollars per year! According to the General Accounting Office of Congress, that is enough to ensure all the uninsured in the U.S (You can do the math yourself by dividing the 44 million uninsured into $130 billion which yields $2954 per person presently uninsured, more than Canada spends per capita.) So if we switched to a single-payer system, we could insure all the uninsured without spending an extra penny! 

But that’s only the beginning. The single-payer system with its enormous buying power negotiates with the pharmaceutical industry for the price of prescription drugs. As a consequence prescription drugs in Canada cost about 60% of what they do in the U.S. All in all the red tape waste and profiteering in our system cost us over $250 billion a year – not only enough to insure the uninsured but enough to provide long-term care at no extra cost.

Massachusetts, the Saskatchewan of the U.S.

The insurers, HMOs, AMA and other backward interests are so powerful in Washington that there is little hope for a single-payer plan at the national level right now. But there is another way – and again Canada provides an example. Canada’s single-payer system did not come into being all at once on the national level but a province at a time. Saskatchewan was the firs province, and when Canadians saw how successful the single-payer system was there, it spread like wildfire across the country. That same strategy can work here, and Massachusetts can be the key. In a poll last year by the Mass Hospital Association, 42% of Massachusetts voters said they would vote for a single-payer system (with 44% against and 14% undecided). That puts single-payer within easy striking distance of a majority – despite all the falsehoods about the Canadian system in the media. And two independent studies commissioned by the Mass Medical Society in 1999 have shown that a single-payer system in Massachusetts would cover everyone and save money – not surprising since that is the same thing that the General Accounting Office, the Congressional Budget Office and many others have shown for the country as a whole.

Another favorable sign for single-payer was last year’s Ballot Question 5, which called for universal health care in Massachusetts. Despite the millions spent by the HMO’s (using our premiums) to defeat Question 5, it nearly won – with a final vote of 48 percent to 52 percent. A better financed campaign for single-payer would certainly win. In the battle to win passage of Question 5, two groups stood out as leaders, the League of Women Voters and the Massachusetts Nurses Association. Nurses have long been in the forefront of the fight for universal health care in the U.S., and the MNA will be one of the most important leaders in the crusade for a single-payer system in Massachusetts.

The MNA can be proud of its role in the struggle for a socially just system of universal coverage. With the MNA and groups like it we can have a single-payer system in Massachusetts soon. Right now legislation for a single-payer system has been filed on Beacon Hill; it is called the Massachusetts Health Care Trust and is supported by the MNA but opposed by the HMOs and insurers. Despite this, public outrage over the health care is on the rise and with it the chances for single-payer grow ever better. Massachusetts can be the Saskatchewan of the U.S.