Health Care Reform 1: Deciphering the Issues for Senior Citizens

Following Congress’ fall recess health care reform will once again be on the nation’s front plate.  SCJ recently committed to the daunting task of presenting health care reform issues in an impartial analysis.  Our editors have agreed on the importance of getting through all the hysteria and shouting, to be able to understand the real issues that affect our lives.  The disrupting influences, whether paid for their attempts to derail or not, will eventually shut up and go home.  The rest of us will still have the same issues and concerns regarding health care.  So it behooves us to try to sort it all out now.

SCJ has chosen to start with analyzing the single payer system.  What does it mean and how would it be managed?  Why is it better or worse than a multiple payer system?

First, a single payer system is just that, a centralized entity that has responsibility for administering health care insurance.  Single payer systems pay for every citizen’s health care as a basic social service, and the tax dollar funds services.  Based on reports from other Western nations in which such a system has been operational for years, single payer systems generally are more efficient and streamlined than multiple payer systems. 

For example, traditional Medicare, a public health insurance program, is a single payer system within the larger insurance industry in the United States, with payment managed through CMS centers (Centers for Medicare Services) throughout the country.  Medicare has, with the assistance of professional and citizen panels, created a protocol for services paid for in full as well as partial payments for identified medical services.  This protocol is provided to every Medicare recipient at the beginning of each year, with changes that have been made which affect the program in the forthcoming year. 

Thus, in the single payer system, rates are set for services provided, payment is made to medical providers based on established rates, individuals may choose their own physician and ancillary medical facilities, and payment is made directly to the physician or facility providing services.  The protocol is comprehensive and no one is excluded.  Advantages of the single payer system clearly are efficiency and lower cost, without compromising medical care. 

Disadvantages of the single payer system go to the heart of the national debate on health care reform:  A single payer system would necessitate the federal government managing health care, and that cuts out private insurance companies which is a major wealth producing industry in the United States.  It is clear that health care reform will not be a single payer system. 

SCJ believes that understanding some system issues will help our readers develop a better understanding of the concerns involved in the debate.  So we start with understanding the single payer system.  Next SCJ will address the ‘Public Option’ and try to analyze that concept and why it generates so much heat in public discussions.