By Jess Fiedorowicz and Dennis Fiedorowicz
Guest Opinion
Iowa City Press-Citizen
Saturday, April 5, 2008
The adjective “broken” has so frequently been used to describe our healthcare system as to become a cliché. Recently an important new study was published in the Annals of Internal Medicine that reveals a growing consensus among medical professionals on a path forward. A solid majority of doctors, now 59 percent, support national health insurance.
National health insurance plans typically involve a single, federally-administered social insurance fund that guarantees health care coverage for everyone. This may effectively eliminate or at least reduce the role of private insurance companies in health care financing, while still allowing patients to choose their personal physician. This growing consensus of the medical community on the need for national health insurance may reflect two values upon which our system fails: social justice and fiscal responsibility.
System’s current flaws
Our current system is unjust. An estimated 47 million Americans now are without health insurance, and more than 50 million are “underinsured.” In Iowa, more than a quarter million are uninsured. Health care should represent a community value. The public invests in schools, emergency services and transportation infrastructure. These goods and services are distinctly different from others in the “free market.” These services are required for public safety and to facilitate participation in a democracy. Health care should not only represent a public need, but also a human right. All Americans deserve access to comprehensive and preventative health care. Our current system has failed in its stewardship, squandering our resources by fostering the growth of a wasteful system, which has lost its focus on advocacy for quality health care. We can empower our citizens through access to comprehensive healthcare.
Our current system is inefficient and fiscally irresponsible. Per capita, we pay the most for health care in the industrialized world yet have poorer health outcomes. We, in fact, spend more public funds per capita on health care than countries providing access to all. The private insurance industry consumes nearly one-third of every U.S. health care dollar on bureaucratic paperwork and overhead. Physicians also have witnessed a deterioration in the quality of patients coverage or patients losing coverage altogether, often leading to their financial ruin. In fact, medical bills cause half of all bankruptcies in the country, and three-quarters of those bankruptcies happen to those with health insurance.
It is time for those seeking the presidency to stop avoiding the barriers posed by special interests, such as private insurance, to delivering affordable, quality health care for all. Unfortunately, our leading candidates for president fail to offer a sound approach to solving the crisis.
Proposed changes
Republican Sen. John McCain’s solution has been described as missing in action. He proposes tax incentives to encourage the uninsured to buy coverage. These subsidies, however, fall short of the cost of adequate insurance. Senator McCain says his plan would let the “free market” work to bring down health costs. In fact, his plan would dis-incentivize businesses from providing coverage for their workers.
Democratic Senators Hillary Clinton and Barack Obama are offering “mandate” models for reform. Under these models, the government would require individuals (or their employers) to purchase private coverage, effectively penalizing the uninsured, while offering an expanded Medicaid-like program for the poor and near-poor. They appeal to social justice through use of the term “universal” though they fall short of delivering health care for all.
The incremental changes suggested by these candidates cannot solve our problems because they leave large private insurance companies in place. State plans based on similar incremental models have faltered or failed. Previously, both Clinton and Obama have voiced support for a single-payer national health insurance system as a solution to the health care crisis, but they have apparently determined it is not politically feasible today. We cannot afford to waste time with incremental solutions that don’t work while our health care system continues to deteriorate.
As the American proverb states, “It doesn’t work to jump a 20-foot chasm in 10-foot jumps.”
Radical reform needed
National health care will require radical reform, a threat to powerful special interests. Insurance companies have added cost with executives assuming huge profits. They have not been good stewards. Insurance companies have created confusion and made our system unnecessarily complex.
Many “insured” are but one major illness away from bankruptcy. The insurance industry spends a great deal of time and effort in constructing barriers or denying payment for testing and procedures physicians request. Physician time is squandered in negotiation with insurance representatives who do not know the patient and lack an ethical duty or fiduciary responsibility to the patient.
Does this make sense?
The new survey of the nation’s doctors suggests otherwise — that national health insurance is not only necessary but also increasingly popular. The findings dovetail with an Associated Press/Yahoo public opinion poll from last December showing nearly two-thirds of Americans favor a similar approach. These polls point the way forward.
The time has come for our political leaders to stand up for the health of the American people and implement a non-profit, single-payer national health insurance system. Will they leap or fall into the chasm? Will we advocate and educate others to allow this socially just and fiscally responsible solution to become politically feasible?
Jess G. Fiedorowicz is a psychiatrist and clinician-investigator at the University of Iowa. Dennis D. Fiedorowicz works as a purchasing agent in manufacturing and lives in Pound, Wis.