Post-Tour Q & A with Gerald Friedman

Mike Huntington relayed these questions to Gerald Friedman. Clarifications in red are Mike’s.


Q. What’s your opinion about the wisdom of individual states achieving single-payer healthcare rather than working politically to achieve a national single-payer system?
A. With our national government gridlock, states’ efforts are needed even though they may not achieve economies of scale and other benefits of national health insurance. We need to start with a few states in order to match the success of OECD countries in providing the best healthcare to the most people at the least cost.

Q. How can we handle the mechanics of single-payer at the state level? We don’t have the administrative machinery of Medicare to achieve a 2% overhead. (We can’t even build an exchange.)
A. A state single payer plan will be far simpler than the exchanges. Billing could be handled through phone terminals at each provider’s office and healthcare credit cards or smartcards.

Q. What changes should Oregon make for a state-level effort to achieve health care for all Oregon?
A. Get the feds on board regarding Medicare and Medicaid. Learn how the VA is negotiating prices for pharmaceuticals.

Q. Is the co-pay is less likely to prevent the patient from making an appointment and getting needed care than a deductible?
A. Dr. Friedman prefers neither although the co-pay could be administratively simple.

Q. Is there any movement by the people toward single-payer in Massachusetts since healthcare costs are not being controlled by Romney Care?
A. Yes! There is a strong movement for single-payer healthcare in Massachusetts. One third of the legislators (13/40 in the Senate) favors single-payer. Donald Berwick is running for governor, calling for single-payer.

Q. What do you think it will take to achieve a national single-payer system?
A. It will take determination by single-payer supporters. Right now it’s time for the ACA to play itself out.

Q. How can we get around the federal employee benefit plans, federal retirees, and other plans over which the state has no control?
A. We can ignore them if we offer the health plan to everyone in the state.

Q. Are you confident that the assumptions you made in HR 676 (Medicare study) are applicable at the state level?
A. No, they are not.


Q. What kind of taxes would you recommend here in Oregon? (Remember we are one of the few states that does not have a sales tax and that depend heavily on personal income taxes to meet the state’s needs.)
A. A top rate would be 9% but this would be deductible from federal income tax assessment. The top federal tax would be 38% making the total 47%.

Q. What type of taxes might people accept?
A. Rich people will probably favor payroll tax, while businesses and corporations will favor an income tax.

Q. What lessons have we learned from Vermont? Do you think they are applicable to Oregon?
A. Vermont and each state will have to deal with the fact of imposing a very large tax. Vermont’s bill based on health care as a human right was passed but without funding explicitly outlined. Now Vermont is struggling to answer funding questions.

Q. You recommend payroll taxes as a part of the formula to finance a single payer plan but with different levels of tax at different income levels. Would the employers match the payroll tax paid by employees? Would large and small employers pay the same percentage?
A. Yes, but in reality both the employer contribution and the employee contribution come from the employee as part of the negotiated salary/benefits package. All payroll taxes are really from the employee. Any amount of payroll tax paid by the employer represents foregone wages negotiated away from employees. Workers wages have been relatively flat over the past twenty years as US business productivity and CEO incomes have dramatically risen. -- Mike Huntington.

Q. How would a single-payer system save money for a small business, that is, one with 50 or fewer employees?
A. A business owner would have personal savings because of reduced or eliminated insurance premiums. Business would increase because consumers would have more money. Employees would be healthier, more productive and reliable. There would be a decreased payroll tax. Recruiting employees would be easier. Even if a business does not qualify for or take advantage of a tax credit through the ACA or does not offer health insurance to its employees (the owner must offer health insurance to employees if the business pays for the owner’s policy) the owner as an individual will save money under a single payer system like everyone else. Everyone else will have more money to spend because they will be paying less for health care. -- Mike Huntington.

Q. What happens to the liability of corporations that have guaranteed future health insurance to retired employees?
A. Corporations (especially multistate corporations) will be relieved of their liability and should jump at the chance to do so.

Q. A tax on financial transactions (“Tobin tax”) should be supported by those who are concerned about stability in the economy. What are some of these groups, and are they actively seeking a Tobin tax right now?
A. National Nurses United and the progressive Caucus of Congress led by Keith Ellison of Minnesota support a Tobin tax. (In other words, liberals and labor.)

Q. Are there financial/cost studies available that a non-financial person can see and understand regarding how or whether universal healthcare payment is viable?
A. Yes. Go to the national PNHP website and enter Gerald Friedman in the search window. Also go to for a two-page summary by Dr. Friedman.


Q. What is rent-seeking?
A. It is making a monopoly out of business to increase one’s profits. Examples are big Pharma’s ever-greening of drug patents; also hospitals and insurance companies buying up physician practices.

Q. Do you expect the pharmaceutical industry, hospitals, and medical equipment makers to argue against a single payer system? Are they going to do this right now, do you think?
A. Not now but later, yes, these companies will pour hundreds of thousands of dollars into a media campaign opposing any single-payer proposal that appears to pose a threat to them.