Single Payer is a Weak Demand

Background: I am the former Chief Information Officer of the Illinois Health Information Exchange (which is essentially dead) as well as for the State of Illinois’ Medicaid system. I have also been engaged in progressive politics since the 60s. This is a short essay I originally posted to FB as well as Science for the People.

While I do support single payer, let me lay out the reasons it is a very tiny step in the right direction and as a result we need a far more encompassing goal for a comprehensive health and human services care system for all people who set foot in this country for whatever reasons they do.

First thing to notice is that the elements of our private healthcare “system” (it’s really not organized well enough to be called a system in my view) are: insurance companies, hospitals, clinics and private practices. Most of these are held by private, for profit corporations.

Our current system subsidizes the private corporations who provide health services by using insurance companies. The public pays into the insurance pools through direct contributions, employer contributions (benefits, really part of a person’s salary or wages) or in some cases via government insurance (Medicare or Medicaid). That is, our current system is based on the public subsidizing private concerns in a variety of ways. One of the downfalls is that not everyone can afford to be insured so that there are many people who can’t get access to any health services since they are too poor.

One result is that many poor people use the emergency room for their healthcare needs. This puts further strain on the system and does not usually lead to good outcomes for the people who are suffering.

Single payer will give everyone access, but it does that by increasing government subsidies to private industry. If you believe as I do that for profit healthcare is an oxymoron, then you will realize that single payer doesn’t really accomplish very much.

So, what should we be demanding in addition to single payer? Here are a few ideas:
1. Healthcare delivery services should all be non-profit and should be carefully monitored for quality by independent non-profits. The non-profit evaluation infrastructure, for the most part, already exists, though it should be greatly expanded in my view.
2. All health related research should be completely open. That is ALL studies need to be published independent of whether or not the experimenter (or their corporate backers) are happy with the results. All studies should be available for free for anyone who wants them. In fact any activity that can be considered research related should be freely available to all.
3. Patent protection should be removed from all medical technology, especially pharmaceuticals. Patents give companies excessive control over the market so they can put their profits before the needs of people. Furthermore, the drive for profits means that pharmaceutical companies (for example) put their research dollars toward drugs that will be the most profitable (think viagra, etc.) rather than drugs that have a bigger impact on health. If you are worried what happens to medical research as a result, that’s easy. It goes back to universities where researchers battle it out for grants, nobel prizes, etc. Pharmaceutical companies should be competing on who can manufacture drugs at the highest quality for the lowest cost and be able to efficiently distribute them.
4. We need a national data sharing infrastructure that allows all health and human service providers share information efficiently so that healthcare services can be targeted at the whole spectrum of activities that impact health and happiness. This means strict data standards to allow for the different components of the national system to understand the data they are receiving from others even if they have never communicated before. I have a paper coming out in IEEE Computer which goes into far more detail. Let me know if you wish to see it.