Single-payer health care has advocates, but Nevada delegation mostly mum

If you think Obamacare is a ruse to bring a single-payer system to America, a federal lawmaker has validated you.

Sen. Bernie Sanders, I-Vt., has introduced the American Health Security Act, which would replace the Affordable Care Act with a requirement that each state set up a single-payer insurance system.

Nevada’s congressional delegation doesn’t seem enthusiastic about Sanders’ proposal. Half didn’t respond to a request for comment. Those who did were either unsupportive or noncommittal.

Chandler Smith, a spokesman for Sen. Dean Heller, said the Nevada Republican is against a single-payer system.

Greg Lemon, a spokesman for Rep. Joe Heck, R-Nev., said Heck is “opposed to a single-payer system and is focused on repealing, repairing, and replacing the health care law with patient-centered reforms that increase access to care and decrease costs.”

And Caitlin Teare, a spokeswoman for Rep. Dina Titus, D-Nev., said Titus would “carefully review” any legislation that comes before the House, but she’s focused now on “implementing the Affordable Care Act and helping thousands of uninsured Southern Nevadans get coverage.”

But lawmakers should reconsider, single-payer advocates say.

One upside would be simplicity, said Laura Martin, communications director for single-payer supporter Progressive Leadership Alliance of Nevada. Some doctors spend as much as a third of their overhead dealing with insurance documents. One payer would slash that expense. It would also make life easier for consumers, who would no longer have to pore through reams of paperwork to figure out which insurer covers what.

Then there’s the moral aspect, Martin said.

“Thousands of Americans die every year because they don’t have health care coverage. We live in one of the best countries in the world. People shouldn’t be dying for such a superficial reason,” she said.

Consumers would also see savings, Martin said, because they’d no longer have to shell out hundreds of dollars a month in premiums and co-pays.

But that’s only because they’d be forking over that much and more in higher income taxes to support a government system, countered Frank Nolimal, an employee benefits adviser at local insurance broker Assurance Ltd.

Plus, those higher taxes might not even be enough, Nolimal said. Medicare trustees reported in May that the system has $34 trillion in unfunded liabilities — benefit promises made without revenue to cover — over the next 75 years. And that’s just for folks older than 65. What happens when you put all 315 million Americans on the system?

“It’s impossible. It just cannot be done,” Nolimal said.

What’s more, many countries with single-payer systems are turning toward privatization, Nolimal said. In 2005 the Canadian Supreme Court ruled that country’s yearslong wait times for basic care such as hip transplants violated human rights, and repealed Quebec’s ban on purchasing private insurance.

It’s also important to note that a report card from the American Medical Association found that Medicare was the biggest claims denier among major U.S. insurers. The agency denied 4.92 percent of claims in 2013, compared with Anthem’s 2.64 percent, Cigna’s 0.54 percent and UnitedHealthcare’s 1.18 percent. Having one payer with no competition and little legal liability would give that payer even more power to deny care, particularly among vulnerable high users such as seniors and premature babies, Nolimal said.

Still, the country can figure it out, Martin said.

“We always have more than enough money to go to war, or to give billions of dollars in tax cuts to corporations who create jobs that pay poverty-level wages,” she said. “But we never seem to have enough money to provide services like health care. It’s about building a strong country. If people are well, they can be educated. They can go to work.”

■ David Paul wants to know: What preventive treatments have to be in each plan, and is there really no out-of-pocket cost?

The law requires insurers to cover dozens of preventive and wellness benefits. And yes, insurers are barred from charging copays on preventive services even if you haven’t met your deductible. So there’s no cost in the sense that you aren’t on the hook when you visit the doctor, though insurance brokers say loading up plans with “free” services raises other costs such as premiums.

There are some catches. The provider has to be in your plan’s network, and some services may not qualify based on age or other factors. A colonoscopy, for example, is copay-free only if you’re 50 or older.

All that said, here’s a general list of what doctors and insurers should not be asking men and women to pay for (deep breath): One-time screening for abdominal aortic aneurysm in men; alcohol abuse screening and counseling; aspirin to prevent heart disease; blood-pressure and cholesterol checks; depression screening; tests for Type 2 diabetes; diet counseling if you’re at higher risk for chronic disease; HIV testing; immunization vaccines; obesity screening and counseling; counseling for sexually transmitted diseases; syphilis screening; and tobacco-use screening and cessation therapy.

If you’re a woman, add tests for anemia, Rh incompatibility and urinary-tract infections during pregnancy; breast cancer genetic test counseling and chemoprevention counseling if you’re at high risk; mammographies every one to two years after age 40; support and counseling for breastfeeding; screening for cervical cancer, chlamydia, hepatitis B and gonorrhea; birth control; screening and counseling for domestic violence; folic acid supplements if you may get pregnant; screening for gestational diabetes; human papillomavirus DNA tests every three years after age 30; bone-density scans after age 60; and well-woman visits for recommended services before age 65.

And kids age 18 to 24 months get autism screening; behavioral assessments; height, weight and body mass index measurements, and obesity screening and counseling; developmental screening before age 3; cervical-dysplasia (abnormal-cell) screening for sexually active girls; blood-fat screenings for kids at high risk of related disease; fluoride supplements; hearing screening for all newborns; vision testing; hemoglobin and hematocrit testing up to age 4; sickle-cell anemia screening for newborns; immunization vaccines; iron supplements for infants at risk for anemia; lead screening; newborn screening for the metabolic disorder phenylketonuria; and tuberculin testing.

Next week: Answers to questions on using your Social Security number as an insurance policy number, and how Obamacare affects Medicare.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.