Letter from Ohio: Single-payer doesn’t provide better outcomes

by Alan Smith on February 16, 2012

Given the failure earlier this month of a bill to enact a single-payer health care system in California, it is a good time to revisit the effort launched in Ohio several times in recent to enact the single-payer Health Care for All Ohioans Act.

Fewer lawmakers voted for the California bill this year than before, while Ohioans voted overwhelmingly last November in favor of a constitutional amendment prohibiting the state from requiring its citizens to buy particular kinds of health policies. Both developments highlight the prospects for a state-run system here as one form of the insurance exchanges that many (but not all) states are fashioning.

As for public interest in a single-payer system, a Rasmussen poll conducted in October 2011 found that 49% of Americans opposed a single government system, 33% favored one and 16% either had no opinion or were undecided.

From both a policy and a practical perspective, there are several facts to be considered when contemplating whether or not a single-payer system would be a good option for Ohio.  The goal of any system should be to secure better health outcomes at no greater cost than current plans, and the best evidence is not predictions, but current systems here and in comparable countries.  That evidence is not comforting.

In the first place, patient outcomes are not improved.  Americans have better survival rates for common cancers than Europeans, and also lower mortality rates from cancer than Canadians.  We are more satisfied with our health care overall and spend less time waiting for care than patients in the United Kingdom and Canada.  Lower-income Americans are in better health than comparable Canadians, and twice as many American seniors with below-median incomes self-report “excellent” health (11.7 %) compared to Canadian seniors (5.8 %).  According to current responses, more than 70% of British, German, Australian, Canadian and New Zealand adults say their government health care systems need either “fundamental change” or “complete rebuilding.”

In order to successfully diagnose the appropriate care, the United States has about twenty-seven Magnetic Resonance Imaging machines per million residents, compared to about six per million Canadians and residents of the United Kingdom.  The top five U.S. hospitals conduct more clinical trails than all the hospitals in any other developed country.

When you compare administrative costs of Medicare, the federal flagship medical benefits program, to private insurance plans, a report issued in 2009 revealed that Medicare’s administrative costs were 24.8% higher on average when calculated on a per-person basis.  Buried deep in the federal health care plan enacted by the Congress in 2010 is a requirement for a recovery audit of money wasted through improper payments by the federal health plans, which the Government Accountability Office estimates to be 8% to 10%, and possibly much higher. Such estimates do not even include the additional burden of fraud.

For these reasons and many more, even though the current American health-care system is fiendishly complex and inefficient in many ways, at least some elements of competition still seem to be the likeliest solution for a system that would be an improvement for all Ohioans.

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