In endorsing a Single Payer health care system this week, the American College of Physicians states that change is necessary because access to health care has seriously deteriorated.

Our recommendations provide evidence-based solutions to our country’s many health care problems – including the appalling lack of access to affordable health coverage, the impending crisis caused by the insufficient supply of primary care physicians, rising health care costs and excessive administrative and regulatory costs.

Having made the endorsement, for single-payer, the ACP (American College of Physicians) follows with a recommendation that universal care be achieved by either a single payer or a pluralistic system that provide equitable and universal access to appropriate health care without unreasonable financial burden. The ACP cites the primary advantage to a pluralistic system is that it builds on the present system and provides freedom for individuals to purchase private supplemental coverage.  Advantages of the single payer plan cited are higher equitability, lower administrative costs, lower per capita health expenditures, higher levels of patient satisfaction, and higher performance on measures of quality and access than systems using private insurance.

On another front, the battle rages among democratic presidential candidates over who has the best health care plan.  However heated the argument, the fact remains that the plans offered by the three frontrunners offer little variation and none of them offer a realistic way to contain the rising cost of health care.  

According to the Physicians for a National Health Program (PNHP) the proposals from all three of these candidates offer a set of common elements, which include:

• Private insurance companies will remain in  


• Large employers will be required to provide insurance or pay    

  into a fund to subsidize it.

• Everyone would be required to have insurance,

  (in the case of the Obama Plan only children would be  

  mandated to have insurance), either employer based or                  

  purchased on their own, with

  income subsidies provided via the tax system.

• Insurers would be required to offer coverage to everyone  

  without limits on preexisting conditions and without huge  

  premium differences based on age, gender and occupation.

• All plans would offer a choice between a private insurance plan  

  and a public plan which would be modeled on Medicare.  

• All claim that they would reduce cost via the expanded use of

  information technology, emphasis on prevention and better

  chronic care management.  

OK, and now just what do these plans lack?  Where have they missed the boat?  Again, according to the PNHP:

• Because multiple payers remain, the savings and simplification    

  of a single payer program will be lost.

• People must purchase insurance but there is no limit on what

  the insurers can charge them.

• There are no regulations that would assure the adequacy of

  benefits or regulate restrictions on choice of hospital,

  physician, or the way that claims are handled or denied.

• There is no simplification of the complex private insurance

  model with its co-pays, deductibles, exclusions and denials.

• There is no assurance of a level playing field between the

  public and private plans.  Insurance company targeted

  marketing will be used to promote the private plans and

  companies will demand the “pot sweeteners” such as those

  they already have with the Medicare Advantage plans.

• Nothing is proposed that will control the rising costs of health


Somehow this all seems like a no-brainer.   The pluralistic plans could be off the table since they will cost more, be less equitable, show lower levels of patient satisfaction, and lower performance on measures of quality and access than a single payer system.  As for the well worn excuse that “America is not ready”, it’s a cinch that America would quickly “get over it” once they started experiencing first hand the higher levels of patient satisfaction that the APC has defined. (Witness our addicition to Japanese cars)  And “America wants choices” doesn’t wash either because America has no choice now.

Funny how only candidates such as  Kucinich and Gravel have the freedom to advocate for a single payer system.  Candidates that have a smaller chance of winning can be quickly dismissed and are largely ignored.  Viable candidates will be destroyed post haste.

So – the lesson would seem to be clear.  Presidential candidates face swift (as in swiftboat) extinction if they get honest about health care.  One of them might sign a bill though if it is placed on the Presidential Desk. We can continue to push the program to our Congressional candidates and convince them to carry the day.  HR 676 (Conyers bill) is the road to reason and more rational health distribution.  The only answer to “not feasible at this time” is “if not now, then when?”