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The (Single-Payer) Elephant in the Room 

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There's the ancient Buddhist story about blind men describing an elephant. One grasps the tail: "An elephant is like a rope." One has an ear: "An elephant is flat and floppy." Another, a leg: "An elephant is like a tree trunk." These isolated conclusions do not describe an elephant. This has relevance to what people hear (and mistakenly think) about a single-payer healthcare system: Some fear losing their private health insurance, others worry about loss of choice and lack of healthcare access, and still others believe that taxes will go up and access will go down. These are limited beliefs that are wholly misleading when describing single payer. Let's take them one at a time.

1) Indeed, private, corporate health insurance would be disallowed from offering treatments that are publicly paid (meaning by all of us) and that privately delivered single-payer health care would freely provide. Private health insurance would mostly be out of business except for certain elective or cosmetic procedures. Why? Nearly a third of what we pay private health insurance companies is wasted as profit and overhead, money that does nothing to promote health. The cost of coping with health insurance companies' pre-authorizations, denials, paperwork, regulations and requirements runs privately practicing doctors an average of $100,000 a year. Many move to Canada (yes, Canada) to practice medicine as they were trained to do without the frustration and financial burden of fighting insurance institutions dedicated to making money over providing care. So, yes, private health insurance would be lost and a fully accessible program of health care would be gained. No more premiums, deductibles, co-pays or point-of-service doctor or hospital bills. We should ask ourselves here in Humboldt County about our own current burdens with healthcare costs: How many of us can say exactly what we sacrifice from our paycheck for a healthcare plan? Do we know how much our employer pays and how that affects what we earn? How much control do we have over what companies our employer might use? In addition, how many of us are aware of the costs to us, personally, for the local governmental health insurance programs we subsidize — our county, city, service districts all buy from private, for-profit corporate interests that cost every one of us in terms of local taxes and fees? At the same time, we subsidize many health insurance programs for (certainly deserving) children, the poor, Native Americans, veterans and others. On top of that, we (those of us not employed by or are a part of any of those groups) must pay for our own private coverage. One important example: In 2017, Humboldt County paid more than $18 million for its 2,377 employees. We all paid for that, plus the levying of Measure Z to plug a $6 million budget deficit that was created by lining the pockets of for-profit institutions. We should ask ourselves, finally, "What good does private health insurance really do?" How much better would it be to have a system that provides a single, streamlined, unified program that impacts everyone equally?

2) That's where "choice" comes in. Private health insurance asks you to make a gamble when you "choose" a plan: Shall I pay less and gamble that I won't get sick or should I pay more and hope that the plan will actually come though for me when I need it? I can have the "choice/risk" of paying a high or low premium for a basically defective product since no one can say what the future holds. It's a cruel choice. A single-payer plan, on the other hand, has no profit motive to deny care wherever, whenever and from whomever you choose. It would be one broad network that, yes, actually does fit all, from cradle to grave, regardless of employment, income, race, ethnicity, marital status, etc. This is a real choice.

3) Taxes will definitely go up. It could be a sales tax, a gross receipts tax, a capital gains tax, a Wall Street transaction tax or simple wealth tax ... there are many ways to find money in this, one of the richest countries on Earth. But as it turns out, the problem of finding money is not even that pertinent, given the cost-savings of a single-payer program. Even the conservative Koch Brothers' group, The Mercatus Center, found that a single-payer system such as proposed by the Jayapal Universal Healthcare Bill (H.R. 1384) would save the U.S. some $2 trillion over the next decade.For the record, however, below is just one possible scenario proposed by the Robert Pollin study conducted by the Political Economic Research Institute of the University of Massachusetts.

• $2.93 trillion: Needed to fund a Medicare-for-All program.

• $1.88 trillion: Current spending by the government for U.S. health care.

• $623 billion: From an estimated 8-percent cost savings to businesses no longer paying for health care premiums.

• $196 billion: Revenue from a proposed 3.75 percent sales tax on nonessential items (excluding food, clothing and other items).

• $193 billion: From a proposed 0.38 percent tax on individual net-worth in excess of $1 million.

• $69 billion: From a proposed long-term capital gains tax.

This revenue (from taxes) and cost savings (for businesses) adds up to $2.96 trillion, more than would be needed to fund Improved Medicare for All.

The difference is that instead of the yearly $3.6 trillion we now pay for health care, with a single-payer program that cuts out the profit and overhead of corporate health insurance, that amount could be reduced to as little as $2.93 trillion.

To bring it closer to home, take a family of four with employer-based health insurance — they pay abut $18,000 per year for a network-restricted plan that can be lost or cancelled at any time. Adding a $2,000 deductible and $1,000 in co-pays brings the total family cost to $21,000 a year — a private tax. Even if this family ends up paying, high estimate, an extra $5,000 per year under single payer, they will save $16,000. It is possible that the very wealthiest (1 percent) of us may see the least reduction in personal healthcare cost but the vast majority will save significantly.

4) As for access and quality — we hear repeatedly from corporate propaganda how much better our healthcare is here than abroad. Nothing could be further from the truth. (We do, indeed, have great health-science, if you can afford it.) Besides paying twice per capita what other countries pay, our outcomes, especially in categories like life expectancy and maternal and infant mortality, are much worse. With 70 million of us un- or under-insured, bankruptcy, homelessness and premature death are the outcomes we endure from lack of access to the health care we need — results unheard of in the rest of the civilized world.

Although no system is perfect and there are always anecdotal, fear-mongering stories, there is not a nation in the world with universal healthcare that would trade for our broken, inefficient, inequitable and irrational healthcare programs. It's time to stop listening to sightless conjecturing about what a single-payer system is all about. With an accurate description of many of the important parts of this pachyderm, let's do it: Let's bring on the whole elephant.

Patty Harvey prefers she/her pronouns, lives in Willow Creek, is a retired teacher and current director of Health Care for All-Humboldt. She has been a Humboldt County resident off and on for more than five decades. For more information about Health Care for All-Humboldt, email [email protected] or join its regular meetings, held at 5 p.m. on the fourth Wednesday of the month at The Sanctuary, 1301 J St. in Arcata.

Have something you want to get off your chest? Think you can help guide and inform public discourse? Then the North Coast Journal wants to hear from you. Contact us at [email protected] to pitch your column ideas.

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