Bernie Sanders Single Payer Healthcare

Re: "Sanders redefines what it means to be a 'democratic socialist'", Sunday Oct 18

Mr. Weigel and Mr. Fahrenthold,

I am writing you regarding an article that was printed in this past Sunday's Washington Post entitled "Sanders redefines what it means to be a'democratic socialist.'"

In the last column of the article on page A7 you write that "Sanders wants the government to start providing it to everybody, a national single-payer system that might cost something like $15 trillion."

By means of establishing my credibility, I have a master's degree in health policy from the Johns Hopkins Bloomberg School of Public Health and have worked on health policy the Maryland General Assembly, National Partnership for Women and Families, and Kaiser Permanente.

My quarrel is with the $15 trillion that you write would cost, presumably, tax payers and health insurance premium payers should a single-payer system be established. The appeal of a single payer system is largely its ability to achieve cost savings, improved efficiency, and improved quality of care over what our current healthcare delivery system produces.

A single payer healthcare delivery system would achieve great economies of scale in administrative costs. A single payer system would not need to advertise its plan to anyone since everyone would automatically be enrolled in it, so automatically you gain the revenues allotted by private health insurance companies to their marketing and sales departments. Electronic health records (EHRs) systems would be fully integrated on one platform, so not only would interoperability of EHRs be assured, but there wouldn't be the need to sustain redundant teams of health information technologists throughout the country to the same extent that our current healthcare delivery system is required to do.

The Centers for Medicare and Medicaid Services (CMS) is the largest payer (health insurance company) in the United States and has an administrative overhead cost of approximately 3%; large, private health insurers in the United States often maintain overhead costs of 12-20%. There would be an enormous potential for cost savings through the creation of a single payer health insurance program.

Savings could be augmented through the augmented purchasing power of a single payer system with regards to the purchase of pharmaceuticals and medical devices. Thanks to the Medicare Modernization Act and its creation of Medicare Part D with the caveat that CMS cannot negotiate down prescription drug prices, the United States is the only developed nation in the world in which the federal government does not negotiate down prescription drug prices, and I would opine that this is much to the detriment of the American people.

Though a single payer system would, presumably cover our population of 12 million undocumented persons in this nation, it is abundantly apparent that our society already indirectly pays for healthcare for these individuals, albeit in an inefficient and indirect manner. EMTALA legislation from the 1980s ensures that every individual who presents at an Emergency Department must be seen, triaged, and stabilized, regardless of their health insurance status. This is written off by hospitals as 'charitable care,' and composes the greatest proportion of our nation's non-profit hospitals' community benefit, which is calculated to be 3-5% of their annual revenue and is provided in lieu of paying federal corporate income taxes. Health insurers factor this provision of charity care into their premiums, so all health insurance premium payers see an increase in their premiums to cover the provision of charity care to, among others, undocumented persons.

If a single payer system were to be implemented, these individuals would be covered and our hospitals would either need to begin to pay taxes to help cover the costs of insuring these individuals, or they would need to find new ways to provide community benefits other than charity care.

In sum, rather than the implementation of a single payer health insurance system costing $15 trillion, in the long-run, it should be viewed as a cost savings tool (at the expense of personal choice). As of 2010, the United States spent more than twice as much on healthcare per capita than any other nation in the world, and for its sacrifice received, as of 1999 according to the Institute of Medicine, healthcare and health outcomes that ranked about 37th in the world in terms of quality on a population level.

A single payer system of health insurance in the United States would reduce costs, improve quality of care, and would in essence deliver high-value care to the American people.

I would like to ask that you correct your previously quoted statement in print. Thank you.