Remodelers are getting irritable, and with good reason: looming lead paint regulations, proliferating “smart-growth” restrictions, rising workers' comp premiums, and month-long waits for permits. In fact, remodelers are fit to be tied about every conceivable type of regulation, fee, or tax, but when I ask their opinion about a single-payer health insurance system, I get an earful about the evils of socialized medicine. This, despite the fact that it is nearly impossible for them to provide a basic health benefit to their employees at a reasonable cost.

Let's put aside the politics of this issue and instead look to what I think are sound business reasons why remodelers should be in the front row of lobbying efforts to convert our broken health insurance model to a single-payer system.

How It Works In summary, here's how a single-payer system works. Instead of billing for services, hospitals are allotted an annual budget by the government to cover all costs. Physicians, most of whom are in private practice, negotiate fee schedules through medical associations and bill for services through a universal insurance form.

In Canada, this system is remarkably efficient. For example, Canada administers coverage for all of its 27 million citizens using fewer people than Blue Cross employs to administer coverage for 2.5 million people in Massachusetts. The main reason is that the single-payer system eliminates the need to determine patient eligibility, obtain prior approval, attribute costs to individual patients, and battle with insurers over care and payment.

Managed care and market competition were supposed to correct this imbalance, but any savings they extracted from clinical expenses were gobbled up by increasing layers of bureaucracy. Current proposals, such as medical savings accounts and voucher schemes, would only add more layers by, among other things, requiring insurers to track out-of-pocket expenses. Plus, medical savings accounts discourage preventive and primary care while failing to curb the high costs of care for the severe illnesses that account for most health spending.

Three Good Reasons What's this have to do with your business?

First, health insurance premiums are the fastest-rising overhead expense in your budget. According to a survey by the Kaiser Family Foundation and Health Research and Educational Trust, employer-sponsored health insurance premiums in 2004 increased an average of 11.2%, the fourth consecutive year of double-digit increases and about five times the rate of inflation (2.3%). The annual employer premium for a family health plan averaged nearly $10,000; single coverage, $3,695. If you priced premiums in 2006, you know they are even higher.

Second, health insurance is a valuable benefit to the kind of workers you want to attract and retain. Most of you believe that providing health insurance is the right thing to do, and with a single-payer system, you won't have to break the bank to provide it.

Third, health coverage by small employers is on the decline, with 5% fewer companies offering this benefit in 2004 than in 2001. Under a single-payer system, there are no insurance premiums. Instead, health care would be funded through some combination of payroll and income tax. If the word “tax” gets your blood boiling, remember this: All businesses would pay, not just those that choose to. Well-run profitable businesses would no longer have to compete with low-ballers that don't provide comparable benefits.

Worried about quality of care under a single-payer plan? The first thing to remember is that single-payer is not a health care delivery system — it is a method of paying for health care. Second, although Canada spends almost half as much per capita on health care as the U.S. (averaging $3,001 vs. $5,635), its citizens are healthier. According to 2003 data from the Organisation for Economic Cooperation and Development (, Canadian infant mortality rates are lower (4.75 deaths per 1,000 live births vs. 6.5 in the U.S.) and life expectancy is higher (80.1 years in Canada vs. 77.71 in the U.S.).

There are many reasons single-payer is a good idea for employees, too — no co-payments, for example, and free choice of providers. To find out more, start here: Physicians for a National Health Program (

Sal Alfano
Editorial Director