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By Giudi Weiss

Health disparities are the result of a lot of factors: disparities in education and income, racism, geographic isolation, and more.

But what gives these factors their power to wreak damage on people’s health? It’s our profit-based, market-driven health care system. The current system puts up financial barriers that keep people from getting optimal health care. It gives providers – doctors, hospitals, outpatient centers, technology centers – incentives to locate in areas where people are well insured. It drives them to offer services for which they’ll be well paid.

This is why hospitals focus their resources on high-profit “service lines” like heart surgery and orthopedics. It’s why they spend millions marketing dubious technologies like virtual colonoscopies and robotic prostate surgery. It’s why doctors go into super-specialized fields instead of family practice. It’s why we don’t have trauma centers on the South Side, where hospitals close those centers rather than get stuck with uninsured patients with expensive injuries. And it’s why providers think “the forefront of medicine” is high-tech medicine, rather than the care people in their own neighborhoods really need: management of chronic diseases like diabetes, hypertension, and asthma; making sure children get immunized and seniors can afford to take their medicines; providing mental health services, or simply educating people to lead healthier lives.

So how do we change this screwed-up picture? How do we make sure people have the care they need, when and where they need it? Many of us think the first step is a single-payer health system, also known as improved Medicare for all.

Under single-payer, everyone in the U.S. is in the same system. Health care is paid for through progressive taxes – if you make more, you pay more. So everyone is fully and equally covered, and you can go to any provider you like. Providers are paid the same for their services, no matter who they treat – not different rates depending on whether you have private insurance or Medicare or Medicaid.

There will be regional boards – that will include patients as well as providers – who determine where new medical facilities and major medical equipment will be located, and how much providers will be reimbursed. That means we’ll have a way to change a system that right now severely underpays the kinds of doctors and nurses who spend time with patients, providing preventive care, primary care, and health education.

Single-payer means no insurance companies denying you the care your doctor says you need. No co-pays or deductibles or other financial barriers. Fair distribution of resources to the 99%.

Single-payer won’t by itself eliminate disparities in health. But it will give us the opportunity, the foundation, the incentives to address them. Single-payer, Medicare for all, is the essential first step. Let’s do it.

Giudi Weiss, member of ISPC and the Gray Panthers Chicago Network, spoke as part of the discussion during a teach-in for Occupy Chicago on December 10, 2011. Steve Whitman, PhD, of the Sinai Urban Health Institute gave the presentation on health disparities in Chicago.