By Alec Pruchnicki, MD

 Medicare Vs. Blue Cross

“ This is not Denmark,” Hillary projected loudly and got heavy applause when Bernie Sanders once again contrasted our chaotic and expensive medical services with the simple, direct government-provided and controlled system used in Denmark.

The Times recently offered that the Sanders health care plan “ would cost over a trillion dollars and would levy significantly higher taxes on most Americans.”

Hillary who has received $675,000 for three speeches from Goldman Sachs warns that with Republican chronic political dyspepsia, we have to hold on to Obamacare as imperfect as it is. Yet my daughter Athena, an accomplished computer programmer, complains that she cannot afford it (Danish health care is free).

The cost per citizen for health care in Denmark is $3,512 and in the US it is double—$7,290.

Danish health care is cheap because there is no Blue Cross peeling off fees between you and the doctor—there is no profit-making, parasitical paper-handling medical business in Denmark.

Here Doctor Alec Pruchnicki explains the single payer system which echoes the Danish solution

—George Capsis

As the contest between Senator Bernie Sanders and Secretary Hillary Clinton heats up, one of the major issues is healthcare reform. Sanders advocates a single payer system and Clinton supports the Affordable Care Act ( ACA, Obamacare ). The ACA has been in the news constantly over the last few years, but what exactly is a single payer system? It is good to see that the mainstream media is finally addressing an issue that Westview examined over two years ago in the June 2013 article “What is Single Payer Health Care.”

In such a system the government acts as virtually the only insurer, paying providers like doctors, hospitals, nursing homes, drug companies and others for their goods and services. Although this has been described as “Medicare for All,” a better description would be “Expanded and Improved Medicare for All” which is the actual title of the HR676 bill Rep. John Conyers has introduced into Congress. The mechanics of implementation are simple.

First, all residents of the United States would be automatically enrolled in this new system, and it would be continu

ous no matter where you lived, what job you had, or what insurance your spouse had. Every provider in the country knows the rules and regulations of Medicare, even those few who don’t accept Medicare payments, so it would not be necessary to construct an entire new bureaucracy.

Second, all co-payments and deductibles would be eliminated so that there would be no need for Medigap like secondary insurance, and the associated paperwork.

Third, exclusions would be eliminated so that a single payer system would now pay for all drugs, long term care, medical equipment, dental work, hearing aids, glasses and other miscellaneous costs. This also eliminates the need for additional private insurance. The government would also have the power to negotiate prices for all of these goods and services and so limit an explosion of expenditures. There might also be renegotiation of fees and payment mechanisms for doctors.

Although this would all be paid for with broad based taxes including increasingly progressive income taxes, corporate taxes, and possibly new payroll taxes, almost all other insurance payments would virtually disappear. There would be a tremendous decrease in administrative costs throughout the healthcare system along with increased price negotiation ability, resulting in major savings for everyone covered. This would more than make up for increased taxes for the average person, not to mention the constant headache of dealing with multiple insurance companies by both patients and providers.

Supporters of the ACA attack this approach as being politically impossible. The ACA, in spite of tens of millions left uninsured, large copayments and deductibles, and poor–quality, confusing health plans actually did get some level of insurance to many millions of people who previously had none. And, it was actually passed, unlike the single payer approach which hasn’t. Incrementally improving the provisions of the ACA, either state by state or on the federal level, is actually something that can be done and can get us to universal coverage. Sanders supporters say that any political upheaval that can get him into the White House would also shake up politics enough that a single payer system actually can succeed, either state by state, or on a federal level.

Although the debate on political feasibility will continue, it should be clear that a single payer system would be simple to implement and workable. “It works in other countries” is an opinion held by Donald Trump, Bernie Sanders, and every other industrial country in the world. Maybe, some day, by us.

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