National, local health care reform at odds

It's a method of paying for health care that is favored by the CEO of Cape Cod Healthcare and was supported by local voters in a recent nonbinding referendum.

But nowhere does President Obama's health reform proposal mention establishing a single-payer system - and that disturbs some local health-care advocates.

Dr. Brian O'Malley of the Provincetown Medical Group is a member of Cape Care Coalition, a local health care reform group that is pushing to bring a single-payer plan to Barnstable County. Cape Cod Times/Paul Blackmore

"It's perplexing," said Dr. Richard Salluzzo, the CEO of Cape Cod Healthcare, the parent company of Cape Cod and Falmouth hospitals. He said surveys show the majority of individual physicians and hospital administrators favor a single-payer system, believing it's the "cleanest route to decreasing costs."

And in November's election, nearly 71 percent of voters in three Cape districts indicated they considered health care a human right and favored establishing a single-payer system for all residents of Massachusetts.

"There's widespread support for the notion," said Dr. Brian O'Malley, a Provincetown physician active with an organization that is seeking to bring a single-payer system to Barnstable County, called the Cape Care Coalition. Cape Care put the question on the local ballot.

In a single-payer system, people's health expenses would be covered under one publicly financed insurance plan that would take the place of private insurance and government programs including Medicare and Medicaid.

The administrator could be a governmental agency or a non-profit organization, but it would draw the money to pay health care bills from taxes, not premiums or deductions.

The concept has caught on in just about every developed nation except the United States, where health care consumes nearly one-fifth of the U.S. Gross National Product, Salluzzo said.

"Nobody comes to us to copy our health care system," he said. "We score toward the bottom on customer satisfaction."

But a single-payer program faces fierce opposition from the private insurance and pharmaceutical industries, the former of which would be virtually eliminated and the latter subject to price controls, O'Malley said.

"Big money is calling the shots, not the needs of the people," he said. "Insurance would lose the control and the handling of most of the money."

Staffers for Sen. Edward Kennedy, who supports Obama's health care plan, told him that hospital associations and trade unions "don't seem to have the will," to push for a single-payer system, Salluzzo said.

Indeed the American Medical Association has spoken out against any development of a public sector insurance plan, saying the insurance system needs to remain private.

There's a reason for that, says Dr. Marylou Buyse, president and CEO of the Massachusetts Association of Health Plans.

Single payer "is one of those ideas that sounds better than it actually is in reality," she said. "It would really turn back the clock on quality and prevention. Most Americans don't want government to run their health care. Look at the post office. Look at the IRS.

"We support universal coverage, and we think Massachusetts did a great job getting people covered," Buyse said. "They did it without a public plan or without a single payer."

According to state officials, nearly all of the commonwealth's residents have health insurance thanks to a health reform program that subsidizes insurance for the state's poorest residents and levies tax penalties on others for not purchasing insurance on the private market.

But advocates for single-payer say the private insurance plans offered in Massachusetts are prohibitively expensive for many families at $1,200 to $1,600 a month, and the publicly subsidized plans are in danger of being cut as the costs of health care continue to soar.

Efforts to improve coverage without containing costs is very expensive, said Alan Sager, a health policy expert at Boston University's School of Public Health. "Without cost control in health care we're all doomed."

Simply eliminating the need for doctors and hospitals to deal with hundreds of insurance plans will save money, as will putting more emphasis on primary care instead of encouraging more highly remunerated specialty care centers to pop up all over, Salluzzo said.

"There are too many MRIs, too many prescriptions, too many return office visits, too much surgery," Sager said.

Salluzzo said that under a single-payer system hospitals would receive an annual budget and would not have to submit insurance claims for reimbursement. Health care costs would be cut from 17 to 14 percent of the GNP in a short time, and eventually to 12 or 13 percent - without rationing, he said.

"It's not how many scans can we sell, but how can we keep people healthy?" O'Malley said. "How do we most efficiently use our money? People pay taxes, but they are a predictable burden. You will never get hit by medical expenses that will bankrupt you."

Both Obama and Kennedy support adding a publicly run health option to the health reform plan, but many Republican leaders have opposed what they called unfair competition for private insurers.

"It would seriously damage the employer-based system that most people have," Buyse said.

But O'Malley said with a single-payer option off the table in Washington, "We have to press to make sure the public plan is tax supported and a good plan."