By Ellen Kaczmarek, M.D.
Citizen-Times (Asheville, N.C.), April 2, 2017
Competition! Americans thrive on it — it is virtually part of our national DNA. From sports to businesses (think free market economy and capitalism) to elections, competition is what we all understand. Being No. 1 is the goal we have been taught to seek.
Yet, we are totally complacent about being No. 37, according to the World Health Organization, in the world. Most of us don’t even realize that’s where the USA stands. In what, you ask? The answer is in health care.
How is this possible? What’s behind this number? This must be fake news! Are these alternative facts?
A flurry of questions accompanies this statement and it should.
For one, How is it possible that we rank No. 37 in health care?
Not to mention that life expectancy in the U.S. is shorter than most of the nations studied by the OECD (Organisation of Economic Cooperation and Development) by about 2 years (78.8 years in the U.S. in 2013 compared with 80.5 years for the OECD average). This is despite the fact that in the United States, health care spending remains much higher on a per capita basis than in all other OECD countries, and was two-and-a half-times greater than the OECD average in 2013 (though with the Affordable Care Act, there has been a notable slow-down in U.S. health spending growth).
The answer is that in most countries (with the exceptions of the U.S., Poland and Greece), universal health coverage ensures access to care for the whole population. This means that prevention of disease and promotion of healthy practices is paramount. It also provides financial protection from the cost of illness, so that medical bankruptcy is nonexistent in those countries.
Second, what is universal health coverage?
Universal health coverage means all citizens have health insurance. This is most cost-effective with a single payer health care system where a “single payer” fund, rather than private insurers, pays for health care costs. The “single payer” part refers to funding, not delivery.
In general, single-payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay. A single-payer fund can have a private health care delivery system, a public delivery system, or a mix of the two (similar to the Medicare and supplemental “Medigap” insurance in this country.)
Isn’t a single payer plan socialism?
A single-payer system is not the same thing as socialized medicine. In a truly socialized medicine system, the government not only pays the bills but also owns the health care facilities and employs the professionals who work there. The Veterans Health Administration is an example of a socialized health system run by the government. The VA owns the health care facilities and pays the doctors, nurses and other health providers.
Medicare, on the other hand, is a single-payer system in which the federal government pays the bills for those who qualify, but hospitals and other providers remain private. (Again, many Medicare recipients purchase “Medigap” policies which cover the difference between the charges for their health care and what Medicare covers.)
Rather than tinker with a system like the ACA that was really only a compromise situation with insurance companies and other special interest groups at best, Americans need to demand a comprehensive reform that eliminates the profit motive from health care and provides a truly universal health coverage system. A single-payer health plan would fill this bill.
Who wants to be 37 when you can be No. 1?
Ellen Kaczmarek, M.D., is a member of Indivisible AVL.org, Health Care Justice of NC and Physicians for a National Health Program.