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MEDICAL COVERAGE States debate single-payer health care



Published: Sun, July 10, 2005 @ 12:00 a.m.



Ohio, California and Vermont are among those considering the change.

COLUMBUS (AP) -- A push for universal health coverage is being rekindled in some states by soaring health care costs and a lack of political support in Washington for federal changes.

Advocates of a single-payer system -- where the government would collect taxes and cover everyone, similar to programs in Canada and across Europe -- have introduced bills in at least 18 legislatures. Some are symbolic gestures, but heated debate is taking place in California and Vermont.

Opponents in California, where 7 million people are uninsured, argue that it would lead to prohibitively high taxes and bureaucratic nightmares. The bill's author, Sen. Sheila Kuehl, says pooling the state's money is the most efficient and inexpensive way of paying for health care.

"The level of misery with private insurers is rising, and that's why we're seeing this increased activity," said Larry Levitt, vice president with the California-based Kaiser Family Foundation, which analyzes health care issues. "But whether one state can succeed, I don't know."

Ballot initiative

In Ohio, a group of doctors, union officials and religious leaders are gathering signatures to get a single-payer health system placed on a ballot next year.

Not since Oregon in 2002 has a state voted on a single-payer health system. Voters there soundly rejected it, as did Californians in 1994. Both times, the proposals came under fierce assault from the medical, insurance and pharmaceutical industries, which launched a battery of television commercials to oppose the movements.

Those defeats led many advocates to conclude that the single-payer movement was dead, given the lobbying power of drug companies and the health insurance industry.

But some advocates are counting on frustration with the current system to eventually turn the tide in at least one state by the end of the decade. Oregon supporters are aiming for another ballot measure in 2008.

Uninsured climbing

Nationally, the number of uninsured Americans is 45 million and rising, and 16 million lack enough insurance to cover all their medical bills. Meanwhile, health care costs keep rising.

Premiums for employer-sponsored health plans rose an average of 11.2 percent in 2004, the fourth consecutive year of double-digit growth, according to the Kaiser Family Foundation. Companies across the country are raising employee fees for health care, increasing co-payments and decreasing benefits.

General Motors Corp. said in June that the crushing burden of providing employee health benefits is part of the reason it will cut 25,000 jobs over the next three years.

Dr. Ida Hellander, executive director of the Chicago-based Physicians for a National Health Program, said state campaigns show that people aren't buying the Bush administration proposals, such as tax credits and private accounts to help more people buy private plans.

"When it comes to serious health care reform, there's a lack of leadership among both Republicans and Democrats," Hellander said. "People are fed up, and it's reaching everyone, even people who thought they had good insurance."

Mohit Ghose, spokesman for America's Health Insurance Plans, the lobbying arm of the managed care industry, wouldn't say if his organization is taking new single-payer movements seriously.

Private insurance extinct

A publicly financed health system in any state would virtually wipe out the private health insurance industry there.

"We believe that a government-run system isn't the solution," Ghose said. "That said, we're willing to work with all groups on improving access to health coverage."

Mainstream medical groups, including the American Medical Association, oppose single-payer systems. The AMA fears they would stifle the development of new medical technology and create longer waits for patient care should government budgets become strapped for money, as many states currently are.

Advocates dismiss those arguments as scare tactics.

"There's no other solution out there," said David Pavlick, a member of the United Auto Workers in Cleveland, which has endorsed the Ohio campaign. "The system we have now is immoral, it's floundering and it's on its last legs."

How it works

A single-payer system would be financed through a mix of payroll tax increases and new taxes on personal income. The new taxes would take the place of insurance premiums that many people currently pay for health coverage, and there would be no out-of-pocket expenses.

States would use their leverage to negotiate lower prices for prescription drugs and other health services. Hospitals and doctors' offices would be relieved of the hassles and expense of dealing with multiple health insurers.

Claims that the system would cost less have merit, said John Sheils, vice president of the Lewin Group, a Virginia consulting firm that conducted a study last year of how a single-payer system would work in California.

The study showed that the state would save $343.6 billion in health care costs over the next 10 years, mainly by cutting administration and using bulk purchases of drugs and medical equipment.

But Sheils said a single-payer system isn't a panacea. States could be hard pressed to keep funding levels adequate during recessions, when tax revenues typically decline. That could lead to delays in patient services.

"There are positives and negatives with all types of health systems," Sheils said. "The question that has to be asked is what are we getting out of our existing multipayer system that is worth all the money we are spending on it?"

Mixed review

Analysts say that despite flaws in the U.S. health care system, voters are still leery of making wholesale changes.

A Kaiser Foundation poll released earlier this year showed that 55 percent of Americans opposed a single-payer health system. Thirty-seven percent favored it.

Knowing that, some states are taking incremental approaches.

Maine started enrolling people this year in a state-private program that offers affordable health coverage to small businesses and families. The goal is to bring coverage to the 130,000 Mainers who lack it by 2009.

"It's really going to the states to push health care reform along," said Janne Hellgren, coordinator for a universal health care movement in Massachusetts. "Washington just isn't willing to change the status quo."




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