A single-payer system--currently in the spotlight thanks to presidential candidate Bernie Sanders' support of the issue--is the most effective way to drive true healthcare reform, according to a group known as Physicians for a National Health Program.
The Affordable Care Act has left many still uninsured or underinsured while healthcare costs continue to rise faster than inflation, according a paper published in the American Journal of Public Health and endorsed by more than 2,000 doctors. What's more, the paper says, private insurers' overhead is significantly more than that of traditional Medicare, and the complex reimbursement system forces providers to waste substantial resources on documentation, billing and collections.
"We propose to replace the ACA with a publicly financed National Health Program that would fully cover medical care for all Americans, while lowering costs by eliminating the profit-driven private insurance industry with its massive overhead," the paper says.
Their proposal would ban private insurers and cover every American for all medically necessary services, medications, devices and supplies, the doctors say, and would fund each hospital with a "global budget" that eliminates per-patient billing.
For physicians, it would allow two modes of payment: fee-for-service via a "simple binding fee schedule," and salaries for those working in nonprofit hospitals, clinics, capitated group practices, HMOs and integrated systems. Despite conventional wisdom that argues otherwise, fee-for-service can still contain costs as long as fees don't unduly reward procedure-oriented specialists, the paper says.
Not all are convinced, however, that the doctors' proposed plan is feasible. Jeffrey Flier, the dean of Harvard Medical School, tells the Washington Post's Wonkblog that the proposal is "massively backward." And Kenneth Thorpe, a professor of health policy at Emory University and prominent single-payer critic, noted that because the proposal overestimates the administrative savings it would create, it would cost more than the current system.
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