After much thought I have decided to shutter my PR business to establish a campaign to bring a single payer healthcare system to the District of Columbia. Obamacare allows for states, which would include DC, to establish their own single payer systems, if they so desire. It would be by far the most sensible thing for DC to do.
For freelancers such as myself it would offer complete health security for far less than what we now pay in health insuracne premiums. For small business if would offer lower healthcare costs and the chance to compete with the largest employers for the best talent, as paying for healthcare would no longer be a factor. For the city it would drastically lower costs as the pool of payers would be universal and we would only be paying for actual healthcare, not health insurace executives. Most of our healthcare money is eaten up in administrative costs, less than half of it goes to actual health care.
What I visualize is a true single payer system, free at the point of service, no copays. The health tax, which would be based on income, would cover everything. That means the healthy adult of 25 would wind up subsizing the health care of the 60 year old heart patient.
This is the system in Canada, here is how it works:
The province does charge a small monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees’ premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.
“The basics” covered by this plan include 100% of all doctor’s fees, ambulance fares, tests, and everything that happens in a hospital — in other words, the really big-ticket items that routinely drive American families into bankruptcy. In BC, it doesn’t include “extras” like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; and if you want a private or semi-private room with TV and phone, that costs extra (about what you’d pay for a room in a middling hotel). That other stuff does add up; but it’s far easier to afford if you’re not having to cover the big expenses, too. Furthermore: you can deduct any out-of-pocket health expenses you do have to pay off your income taxes. And, as every American knows by now, drugs aren’t nearly as expensive here, either.
Filling the gap between the basics and the extras is the job of the country’s remaining private health insurers. Since they’re off the hook for the ruinously expensive big-ticket items that can put their own profits at risk, the insurance companies make a tidy business out of offering inexpensive policies that cover all those smaller, more predictable expenses. Top-quality add-on policies typically run in the ballpark of $75 per person in a family per month — about $300 for a family of four — if you’re stuck buying an individual plan. Group plans are cheap enough that even small employers can afford to offer them as a routine benefit. An average working Canadian with employer-paid basic care and supplemental insurance gets free coverage equal to the best policies now only offered at a few of America’s largest corporations. And that employer is probably only paying a couple hundred dollars a month to provide that benefit.
You read that correctly, in Canada a family of four pays $108/month in health tax for inclusive coverage. No out-of-network doctors, no drugs that are off the list of covered drugs, complete coverage for $108 a month. That is what we could have if we cut out the health insurace parasites.
Currently the DC government pays a company like Kaiser Permanente $4,847 a month with the DC worker paying an additional $1,171 a month. Imagine if DC could pay $108 per month per employee and get more complete coverage. In 2003 PNHP estimated that DC would save 1.2 billion with a single payer system.
Why haven’t we done this already? Because the health insurace companies in our country have enormous power and becase we give up without trying. Our biggest opponents are the ones in our head.
So I have decided to lead the effort to bring single payer to DC. I will be blogging here until I am able to set up an organization with its own website. If you want to help with this effort, contact me at email@example.com.