Former Kansas Governor and now Health and Human Services Secretary Kathleen Sebelius
wrote an op-ed that appears in Yahoo! News. The sentiment of the article is correct, that the current system is not sustainable. She then mentions a degree of consensus around “cost controls, guaranteed coverage and providing more choices.” (I’m not sure what “providing more choices” really means because I believe that all Americans just want excellent healthcare. One choice.) She then goes ahead and points out the problem of the 46 million Americans not being covered and millions more being underinsured. She correctly points out that Republicans are obstructing the process. Right here is where the good article ends and the murky article begins.

She talks about more affordable choices. She does not stand up strongly for a public option. She does not mention that the most affordable option with low overhead and a guarantee that insurance companies can’t weasel out of it is a single-payer (government payer) system. I cannot think of anything that is more affordable than saving $700 billion by creating a single-payer system. There’s no other proposal on Capitol Hill that will save this kind of money.

She is correct in saying, “we have to align incentives for doctors and hospitals.” I have stated this differently. I have said that we need to pay primary care physicians and hospitals differently. They need to be paid to take care of a population of patients. Therefore, you remove the incentive of ordering a bunch of tests or seeing patients over and over again if they don’t need to be seen that often.

By creating a single-payer system, we are all invested in each other’s health. We want physicians to be proactive and not just treat us we were sick. Therefore, I have proposed that primary care physicians who keep a population of patients healthy (keeping diabetes under control, controlling hypertension and the like) should be paid bonuses. You can call these bonuses — wellness bonuses. Physicians and hospitals are awarded for instituting programs which keep people healthy.

I understand in this political environment that many Democrats are afraid of the single-payer system. They need not be afraid. Instead, they need to embrace the single-payer system and explain it so that people understand that they keep their doctor, they keep their same hospital. Those choices do not change. Secretary Kathleen Sebelius has written a good article but she needs to go the next step. We need leadership from her, from President Obama, from Speaker of the House Nancy Pelosi and from Senate Majority Leader Harry Reid.