Rescue Plan: Single-Payer System Is the Answer to Health Insurance Woes

Michael Moore’s documentary Sicko indicts private health insurance and calls for its abolition.  Sicko joins an American tradition that includes Lewis Hine‘s photographs of child laborers (1908) and Harriet Beecher Stowe’s antislavery novel Uncle Tom’s Cabin (1852), two examples among many.  But can Moore’s theme change our nation in 2007?

Private health insurance, usually obtained if our employers offer it, has dominated access to American medical care for three generations.

Two generations ago, when employer-based private health insurance definitively failed to provide for the elderly and the poor, Medicare and Medicaid were enacted.

As the most recent generation of Americans has grown up, the failures of private health insurance have come to touch each of us in some personal way.

Private health insurance has failed to:

  • Remain affordable.  Premiums, co-pays, and deductibles mushroom, and employers pass their costs on to employees.  Health care benefits present a sticking point in nearly every union contract.
  • Protect the patient-physician relationship.  Insurance company interference in decisions that should be made between doctor and patient has become routine.  Insurance rules delay and deny payment for diagnostic tests as well as treatments and very often control where a patient may seek care.
  • Contain spending.  Health costs soar, both per capita and as a percent of gross domestic product.
  • Improve quality.  The United States lags far behind all other developed nations on a broad index of health outcomes.
  • Reverse health disparities.  Consider appalling data from the Centers for Disease Control that the ratio of black to white mortality among newborn babies has worsened in recent decades.   A study by former Surgeon General David Satcher showed not only that blacks continue to die sooner than whites but that the overall ratio of black to white mortality changed very little between 1960 and 2000.
  • Cover the uninsured.  Census Bureau data show that more than one in five Americans lack insurance for part of the year and about one in six have no health insurance for 12 consecutive months or more. 

A few years ago, the Journal of the American Medical Association ran a memorable article about the personal suffering and death of victims of our hodgepodge arrangement of access to medical care.  The author, a Texas physician, lamented “the system of no system.” 

Michael Moore calls it “Sicko.”

But mainstream politicians recoil from the suggestion that private health insurance has no legitimate role in society, though they repeat the word “universal” as if in a delirium.  Recent state legislation, with the exception of California’s single-payer bill, has aimed to rescue private health insurance from a crisis of its own making (instead of the people hurt by the crisis.)

Look at Massachusetts, which this year required individuals to purchase private health insurance.  With confusing, expensive and limited-coverage plans, bloated bureaucracy, thousands remaining uninsured and costs continually rising, the bipartisan-supported “Massachusetts miracle” already stumbles toward failure.

Americans know from personal experience that private health insurance ties up an enormous amount of resources in administrative costs and profits — at least $350 billion annually, according to an article in the New England Journal of Medicine.  American and Canadian Medicare both have proven for decades that very low overhead costs are feasible in a public health program.

The resources wasted by private health insurance on administration and profit could be used instead to cover all necessary medical care, for everyone — primary care, specialty care, hospital care, dental care, mental health care, home care, rehabilitation, nursing home care and prescription drugs.

Earlier this year, in a New York Times/CBS News poll, 64 percent of those asked agreed that “the federal government should guarantee health insurance to every American.”

To share risks, to control costs, to protect the doctor-patient relationship, and to reverse shameful disparities, a single-payer system of public health insurance, with everybody in and nobody out, presents the only proposal that is both practical and just.

This is the idea behind a bill in Congress, H.R. 676: “The United States National Health Insurance Act.”  Among its 78 co-sponsors are Reps. Michael McNulty of Green Island and Maurice Hinchey of Saugerties.

Michael Moore hopes to convince America that our sick-o system of no system, based upon private health insurance, is a disgrace.  Can a film move us to embrace a national health program?

See you at the theater!

Andrew D. Coates, MD, secretary of the Capital District (NY) chapter of Physicians for a National Health Program (at, practices medicine in Albany, NY.  Please also see the PNHP-sponsored website  This article was first published in the Times Union (Albany, New York) on 1 July 2007.

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