Marcia Angell's prediction for 2003
The Washington Post
January 5, 2003
Outlook
They Can See It Coming
We decided to ask forward-looking writers and thinkers: What can't we see that's coming?
Marcia Angell, former editor-in-chief of the New England Journal of Medicine:
I see the rapid collapse of our health-care system in 2003. The inherent failings of this system were partly masked by the prosperity of the late '90s. But with increasing unemployment, businesses no longer have to compete to attract workers by offering full health benefits. They're free to drop benefits altogether or limit them severely, and they can require workers to pick up more of the tab themselves.
So people end up paying for their health care out of pocket or doing without. That's what I mean by the collapse of the system. About the only part that is working is Medicare, and that is a publicly funded, single-payer program within the system.
I don't think we're going to wake up some Tuesday morning and say, "Oh look, the health-care system collapsed," but it will become glaringly obvious over the next year that it is woefully inadequate. And since so much of our health-care dollar is diverted to profits and overhead, it will also become clear that it is grossly inefficient.
The question is what will take its place. Either the United States can join every other advanced nation and develop a national single-payer health-care system, or we can keep going the way we are and eventually have a three-tier system in which the wealthy get whatever health care they want, the middle-class gets some kind of stripped-down managed care, and the rest get nothing. In that respect, we would be just like a Third World country.
A national single-payer system -- essentially Medicare for everyone -- would be both better and cheaper.