It has long been debated whether healthcare is a fundamental human right. This idea is the foundation of recent legislation proposing that Rhode Island adopt a “Single-Payer” health system.
A Single-Payer health system is a health system primarily driven, funded, and regulated by government. The Single-Payer model is similar to the Medicare model, whereby, the government provides financial support for healthcare services and goods, and establishes a fee structure around the reimbursement of those services and goods.
I have studied the various manifestations of Single-Payer health systems in countries such as, Israel, France, Germany, and Japan. I can dive deep into the nuances of each of these Single-Payer systems, but instead, I will focus on two reasons why Rhode Island should not transition to a Single-Payer health system.
The Costs Burden
The State of Vermont recently experimented with a single-payer system. In the end, Vermont went so far as to increase employer payroll tax to 10.6% and employee payroll tax to 3.6% and yet, the system was still unsustainable.
Recent opposition to Single-Payer legislation in Rhode Island has been fueled by cost concerns. It has been estimated that transitioning to such a system would cost Rhode Island $5B annually, which Rhode Island taxpayers would likely have to pay for. How was the estimate derived? On average, annual health expenditures for each person in Rhode Island approximates $5k. Therefore, if you are covering each resident of Rhode Island, then you have just acquired a $5B bill. However, healthcare systems are far too complex to formulate cost estimates based on multiples of health expenditures and population size.
Healthcare systems embody multiple insurers, providers, technicians, facilities, technology infrastructure, and a network of business executives at the intersection of each decision. The “Single-Payer” legislation that has been proposed for Rhode Island aims to address that complexity by placing all financial and purchasing power into the hands of a few state government officials.
Developing a health financial system that serves as a unifying hub for each layer of healthcare (i.e., providers, patients, vendors) would be expensive, and with an administration that lacks healthcare and technology expertise, it would undoubtedly predispose Rhode Islanders to extraordinary risks. As an example, let’s remember the failed design and deployment of the Unified Health Infrastructure Project (UHIP), which harmed many Rhode Island families.
The Evolving State of Health
A well-known single-payer model is the Israeli healthcare system. Israel’s healthcare system is managed by ministries (i.e., finance and health), which embody a group of experts representing the fields of economics, finance, technology and healthcare. The Israeli single-payer system also provides several public insurance options and yet, Israel has sustained free market principles by allowing over sixty private supplemental health insurers to co-exist in that environment, and to compete for business, and to provide patients with more options. Nevertheless, the unexpected rise in chronic diseases has presented new financial challenges to that system.
We have long been challenged with a high prevalence of diabetes, obesity, and heart disease. We have been subject to hyper-inflated drug prices. We have been victims to a health insurance industry with few options and ever-increasing health costs.
We are not the last in line for a Single-Payer system, but rather, we have evolved beyond a Single-Payer system.
The Road Ahead
There are those who believe that the right to health resides in the “opportunity” to live a healthy life. An “opportunity” defined by the availability of healthy nutrition, quality education, stable personal finances, clean environments and living conditions, and safe neighborhoods. It is through the edification of communities and improvements in the aforementioned societal realms that we can positively influence health choices and outcomes. The road towards a healthier Rhode Island requires a more comprehensive approach to health education and care coordination, a nurturing environment for our healthcare workers to grow and thrive, and a stronger voice with which the people, and the health providers who serve them, can challenge the institutions that contribute to rising health costs.