18 April 2006

The world is upside down

The conservative Wall Street Journal endorses a single-payor health care system.

Why doctors should support it:

Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.

The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.

The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.


Why consumers should support it:
A single-payer system would increase access to care for the uninsured and the underinsured, including the working poor. It would lower total health costs, in part by replacing 50 different state Medicaid programs and umpteen insurers with one system. This approach has the potential to improve quality and lower costs by improving care for chronic illnesses such as diabetes, high blood pressure and heart disease.
Of course, nothing is going to happen for the next 1007 days. But I like the fact that this topic is getting attention, serious attention from both sides of the aisle. From Romney and the WSJ on the right, to Krugman and the pack on the left. And while I have soured a bit on the Massachutsets plan (see here for a great explication why), the fact that a right-wing presidential candidate championed a "universal" health plan will make it a lot harder for the wingnuts to demonize it as liberal big government.

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