Thursday, September 17, 2009

The "single payer" should be you

When some people say that the U.S. should have a "single payer" health care system, they're generally talking about a system in which government is the exclusive payer of all health care bills. It's tempting to think that in such a system, the money comes from some magic place in the sky, but of course, it ultimately would come from higher payroll or other taxes.

If you take a broad perspective, though the U.S. already has multiple forms of single payer systems. Medicare and Medicaid and the Veterans' Health Administration provide health services that are directly funded by taxpayers. Employer-based and individual health insurers collect premiums from employers, employees, and individuals to create large pools of money that pay the health care bills of their members. In all of these cases, the "single payer" is, ultimately, you.

The trouble with all of these systems is that much of your payments (up to 40 percent in some cases) pay for administrative costs rather than actual health care services. But what if there was a way to cut out the middle men? The Seattle-based practice Qliance Primary Care has developed one innovative solution - charging a flat monthly fee for the full spectrum of primary care services. The practice offers "same or next-day appointments for urgent care, unhurried 30 to 60 minute office visits, 24 hour phone and email access to a physician and the convenience and cost savings of an on-site x-ray, laboratory and 'first-fill' prescription drug dispensary."

Previous medical groups that utilized this business model often charged exorbitant fees, leading critics to label them "boutique" or "concierge" medicine, available only to the wealthy. In contrast, Qliance's fees are quite affordable: from $49 to $79 per month. This fee, combined with a catastrophic health insurance policy to protect against unexpected ER visits or hospitalizations, is significantly less expensive than traditional insurance policies - which makes sense, since 100 percent of payments go directly to the practice rather than being filtered through insurance bureaucrats.

So why aren't there more advocates for a "single payer" health system in which the single payer is you?