This man wants to get rid of co-pays and deductibles for health insurance, which he calls “remarkably crude ways of controlling demand.” He has a better idea — health insurance for all in a system that allows private coverage with public funding.

Dr. Oliver Fein is taking the reins at Physicians for a National Health Program, a 20-year-old organization of more than 15,000 doctors who support a single-payer plan for all, similar to Medicare for those over 65.

He told about 30 doctors and medical students over dinner Monday night at Mory’s (that “fabled Yale drinking club,” as one diner described it) that under the current system, the U.S. ranks highest in the number of preventable deaths among 19 developed nations. That’s because 45 million Americans are uninsured, and more than 50 million are underinsured.

One of those attending was Yale historian Jennifer Klein, who wrote a book about what she called “our screwed-up health care system.” She said that back in the 1930s people were organizing health care as a community benefit; it wasn’t a profit-_base_d system. “It had nothing to do with insurance companies, and it had very little to do with employers,” she said. Click here to hear a two-minute lesson in how the system evolved to its current state.

Responding to those flaws, Fein, a practicing physician and professor of public health at Weill Cornell Medical College in New York, said health coverage must be universal, covering everyone. As for undocumented immigrants, he proposed the wording of any new health insurance law should stipulate that “residents” are covered, but then lawmakers should decide what length of residency is required to be eligible for coverage.

Fein enumerated other requirements of a new paradigm of health insurance. “It must be comprehensive. Would there be any exclusions? Yeah, probably, you know, tummy tucks, botox for wrinkles. I might even exclude a private room in the hospital unless medically indicated,” such as if a patient has a roommate with tuberculosis.

“It must be tier-free. Now we have one tier for the elderly, another tier for the poor, another tier for those who are employed, another for those who are uninsured. We really need to think of a single tier of care.”

That’s when he proposed eliminating co-pays and deductibles, “because what they do is cut demand for needed services equal to the amount they cut for unneeded services.” Another tenet of a tier-free system, he said, is that private insurance can supplement, but not duplicate, public coverage.

He said public funding should replace the “regressive” funding of premium-_base_d financing for health insurance. “Right now, the president of a company usually pays the same premium as the secretary in the company. Are their incomes equal? Absolutely not.”

And finally, the new system must have low administrative costs, for which the U.S. has to look no further than its own health care program for elders. “Medicare has an administrative cost of three percent,” he pointed out, “whereas the average commercial insurance in this country has an overhead and profit of roughly 19 to 20 percent.” For some insurers, that number goes up to 30 percent of medical costs.

This reporter was seated next to Veronica Marer, a Canadian-born solo private practitioner in Connecticut. She said with her roots in Canada (and relatives also in France), she’s learned a lot about the single payer health systems in those countries, which she believes are better for more people than the U.S. system. But, she added, “Of course it’s not perfect; there’s rationing of care and waiting for non-emergency procedures.” But she supports single payer not only because it covers more people, but because it’s much more cost-effective. She said with such a system in place, she could do with one fewer of her 2.5 employees. “Not that I want to get rid of anyone,” she hastened to add. “I love my employees.”

more: http://www.pnhp.org/news/2008/june/fein_calls_for_takin.php