A group of more than 2,000 doctors called for the establishment of a government-run universal health system in the US, in a paper in the American Journal of Public Health.
According to a proposal released Thursday, the Affordable Care Act is not far enough in removing barriers to access to health care. The doctor's bold plan calls for the adoption of a single payer system similar to Canada, called the National Health Program, which will guarantee all population health care.
The new single payer system will be funded largely by existing US government funds. Doctors point out that the US government has paid two-thirds of all health care expenses in the US, and a single payer system will reduce administrative costs, so the transition to a single payer system will not require a significant additional expenditure.
"Our patients cannot afford treatment and do not have access to the care they need, while the system is increasingly wasteful, wasting money on bureaucratic fees and unreasonable prices from drug companies," said David Himmelstein, a professor at CUNY's School of Public Health at Hunter College and lecturer in medicine at Harvard Medical School.
Himmelstein, one of the plan's authors, said the proposal was intended as a call for doctors and other health professionals about the causes of the single payer model. According to the paper, even with the entry into force of the Affordable Care Act many patients "face increasing mutual payments and deductibles that jeopardize access to care and make them vulnerable to damaging medical bills". Despite the current high level of health care spending in the US, health care outcomes are worse than comparable well-funded countries.
"There is a belief that we can carry out this approach gradually and get there in small steps and one of the advantages of having passed the ACA is that simple steps cannot do the work, and by making it easier to make arguments that we requires more fundamental changes, "Himmelstein said.
Under the proposal, all residents of the United States would be able to consult the doctor of their choice in the country and be treated in any hospital. With guaranteed coverage and no co-insurance, deductibles and premiums, patients would not have financial barriers to seeking care, which would lead to greater use of the system and better health outcomes, says Himmelstein .
The additional funds would consist of modest tax increases in exchange for the elimination of insurance premiums, deductibles and co-payment.
"We should abolish insurance companies, there is no way around that," Himmelstein said. Employees of private insurance companies would be retrained for other jobs, he says, and would receive investment assistance. Insurance CEOs, who earn millions of dollars in salaries, would not benefit from a comparable investment, Himmelstein said ironically.
Drug costs would be negotiated with pharmaceutical companies in the same way that other countries with a single payer system are already negotiating lower cost drugs. Currently, drug prices in the United States are among the highest in the world.
Although Himmelstein acknowledges that the doctors' proposal would meet opposition from political and commercial interests, and that he does not know when such a system would realistically benefit from the necessary political support, he hopes that a growing number of Americans a single payer system, the pressure will continue to mount on the government.
Propose a single payer system in the United States is not new. Vermont had previously attempted to implement a single-payer system, which had been passed by the legislature, but had been closed by the governor, who had already provided support, when the estimated costs exceeded what the state could do. to permit.
Coloradans will vote in November on whether to introduce a single payer system across the state. One of the movement's leaders in Colorado is state senator Irene Aguilar, who is also a doctor. The Colorado proposal would be funded by an increase in payroll taxes of 7% for employers and 3% for employees. For the self-employed, this would result in a 10% increase in the tax.
But Himmelstein said that this type of reform can not be done state by state. The physician system is partly dependent on cost containment through the establishment of a single payer with the power to negotiate drug prices with pharmaceutical companies, as well as the elimination of many levels of bureaucracy in the area of drug costs. billing and insurance registration.
The American Medical Association (AMA), the largest physician organization in the United States, opposed the idea of a single payer model. When contacted, WADA emphasized its policy regarding the evaluation of health reform proposals, including: "The unjust concentration of payers' market power is detrimental to patients and physicians, choice or the ability of doctors to choose their mode of limited or refused. Single payer systems clearly fall under such a definition and, therefore, WADA should continue to oppose it. "
But Himmelstein sees the change at the corner of the street. "I think that WADA and its member organizations are slowly starting to emerge and I am confident that they will eventually arrive." He highlighted the adoption of resolutions by some state medical associations that make up WADA members to study. the impact of a single payer system as an indicator of change.
For Himmelstein and other editorial writers, the main indicator of change seems to be the discourse of a single payer system in the presidential primaries, which has drawn attention to the issue.
"Bernie Sanders has shown that you can do extremely well on this issue," said Himmelstein, convinced that if enough Americans demand a single payer system, Congress will have no choice but to change advice and support. But what Americans really think of a single payer system is much more obscure. Some polls show that the majority of voters favor a single payer system, but some polls show that this support decreases when respondents are asked to forgo their private health insurance and pay additional taxes.
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