Benefits of a Single-Payer Healthcare System

Oncologists have a "moral and ethical obligation" to their patients to advocate for a single-payer universal health insurance program, according to two oncologists who stated their case in an editorial.

A single-payer system would simplify healthcare delivery for patients and providers without sacrificing quality of care, said Ray Derasga, MD, and Lawrence Einhorn, MD, in an editorial published online in the Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.

The switch to such a national system would face huge and innumerable challenges, but gradual implementation, perhaps even on a state-by-state basis, would reduce the administrative burdens, they wrote.

"Because the [Affordable Care Act or ACA] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent," said Derasga, a retired oncologist in Chicago, and Einhorn, of Indiana University in Indianapolis.

"Life is short, especially for some patients with cancer; they need help now."

Making Their Case

Derasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:

• Reduced administrative costs, which currently account for almost a third of healthcare expenditures
• Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
• Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
• Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
• Implementation of proven cost-containment strategies, which are absent from the ACA
• Improving quality of care and outcomes by increasing access to care
• Reverse the trend toward for-profit, investor-owned healthcare plans
• Preserve physician's income potential, as judged by experience with the Canadian healthcare system

The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.

The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.

"Lower drug prices would not jeopardize drug innovation," Derasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research."

The issue of drug pricing is especially relevant to oncology, they added, where the median cost of a new drug has risen to $10,000 a month since 2010.

The authors called on ASCO to lead the way in advocating for a single-payer system, which would orient healthcare "toward care giving, not toward maximizing investors' profits."

ASCO has taken no position on a single-payer or other type of healthcare system, said ASCO chief executive officer Allen Lichter, MD.

"We have long advocated that every American deserves to have insurance coverage," Lichter told MedPage Today. "We have advocated that those patients who receive a new cancer diagnosis and don't have insurance should be placed into Medicare because facing a cancer diagnosis without insurance lowers your risk of survival, as Dr. Derasga and Dr. Einhorn pointed out in their paper."

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