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Daniel Bryant is a retired internist who practiced in Portland, as well as at Naval Air Station Jacksonville in Florida. He is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.
One of my most unpleasant experiences as a physician was our small practice’s monthly review of patients’ unpaid bills. Our bookkeeper would ask me whether I wanted to call my delinquent patients about their bills, keep seeing them even if they weren’t paying or send them to a collection agency.
What I did about any of those delinquent patients, I don’t remember (or have repressed out of guilt), but their difficulty paying their medical bills has led me to look into why that problem exists in the health care system in which I worked for many years. I’ve learned two things: Health care prices in the U.S. are higher than in peer countries and many costs are hidden, making it hard for people to fully anticipate how much they will owe for their medical care.
The costs of health care in Maine extend far beyond what we see on our own medical bills. Workers contribute directly to Medicare through payroll deductions and indirectly through federal income taxes, with a significant portion of those taxes supporting Medicare, our federal health insurance program for seniors. And nearly a third of our state and sales taxes go to the Department of Health and Human Services and MaineCare, the state’s Medicaid program.
Also, employees bear the burden of their health care premiums and these include hefty administrative fees paid to insurance companies. Employers, facing rising health benefit costs, may hold back on wage increases, adding to the hidden cost of health care for workers.
Even property taxes contribute: I found in my town’s budget that 6 percent of those taxes go to funding health insurance for municipal employees, a cost passed on to homeowners and renters alike. As businesses spend roughly 7 percent of their labor costs on employee health coverage, the prices we pay for everyday goods and services, including utilities, groceries and entertainment, may be inflated to accommodate these expenses.
All these factors mean that Mainers are likely paying up to three times more for health care than they realize. We have to acknowledge and address these hidden costs in our ongoing discussions about health care reform.
To address these high and hidden health care costs, some propose replacing the current system with a simpler one where everyone pays a clear, straightforward premium based on their income, not their health care needs. This so-called single-payer system, which would continue free choice of private and public providers, would make costs and benefits more transparent. Nationally, it’s represented by the Medicare for All bill, and more than 20 states have considered similar single-payer plans at the state level. For most people, this income-based premium would be much simpler and, as I found in my research, published recently in the Maine Policy Review, should cost no more than what they are currently paying.
Anyone interested in pursuing this approach has several options to do so. Contact organizations supportive of the single-payer model, such as Maine AllCare or Physicians for a National Health Program, to learn more. Submit testimony to the new Maine Office of Affordable Health Care at one of their annual hearings, asking them to study it and compare it to the public option (a state plan that would compete with commercial plans) they are now considering. Ask their U.S. senators and representatives to co-sponsor the Medicare for All Act as well as the State Based Universal Health Care Act, passage of which would facilitate further study of a single-payer plan for Maine.
That’s what I should have talked to my patients about when I called them.
