America’s ailing health care system
Editorial
Roanoke Times
Published: Monday, March 20, 2006
The free market approach to health care has given the U.S. a system both mediocre and expensive. It’s time to try single-payer insurance.
The good news from the largest study of U.S. health care quality is that Americans receive essentially equal quality of care, regardless of race, gender or income.
The bad news is that care is equally mediocre.
“Not only is no place safe, no one is safe from poor quality,” said Steven Asch, lead author of the study, which was published in the New England Journal of Medicine. “No matter which group we looked at, whether they were black, white, rich or poor, uninsured, insured, educated, uneducated, all of them were receiving mediocre care.”
The United States has the most expensive health care system in the world — both in terms of raw dollars and as a percentage of gross domestic product. The American people are clearly not getting their money’s worth from the current market-driven system.
That system, as Paul Krugman and Robin Wells argue in the latest issue of The New York Review of Books, is incredibly inefficient. As health care costs continue to rise — largely because of increasing medical technology — the price of that inefficiency grows.
An editorial in the latest edition of The New Republic lays out nearly the same convincing case as the one by Krugman and Wells, calling for the United States to adopt a single-payer health system.
Private health insurance companies spend a lot of money and time in an effort to “compete over who can enroll the healthiest patients, since that is the surest way to improve profit margins,” The New Republic editors wrote.
But the expense of culling the unhealthier patients doesn’t increase the overall efficiency of America’s health care system, since somebody will end up paying for their care.
The hallmark of the current system is a fragmentary mess of insurers and providers that “add cost without adding value,” Krugman and Wells write.
That’s how to construct the world’s most expensive mediocre health care system.
President Bush and others on the right think free market economics can solve this. They want consumers to pay more out-of-pocket costs themselves, using tax-free health savings accounts. The “logic” of that argument is that if health care consumers are spending their own money, instead of being sheltered from the true cost of health care by insurance, they’ll make wiser choices.
Several studies, though, have shown that, while patients who pay more out of pocket do cut back on medical expenses, they do so indiscriminately, cutting back equally on beneficial and questionable medical procedures.
Health savings accounts also siphon the healthiest and wealthiest from traditional insurance plans, exacerbating current problems by leaving the weakest and sickest in the insurance pool.
Experience elsewhere in the world, especially Taiwan and France, suggest that the inherent efficiencies of a single-payer system would allow the United States to cover the 46 million uninsured Americans while spending less than it does now.
The best way to make health care affordable — and concentrate efforts on improving quality for everyone — is to spread the risk as broadly as possible. A single-payer system will do that. The free market system for health care has failed.
