By David Ray, M.D.
Times Union (Albany, N.Y.), April 8, 2015
As we approach the 50th anniversary of the Medicare program, and the third year of the Affordable Care Act, what can we say about the state of America’s health care? For one thing, this: While the United States has centers which offer some of the most sophisticated medical treatments in the world, there is unequal access both geographically and economically to that care.
The Johns Hopkins School of Public Health published a paper in 2014 comparing health care in the 11 most developed countries in the world. The U.S. ranked at or near the bottom in access, cost, efficiency, safety and overall population health. Yet per capita cost in this country, at $8,500 per year, is nearly double that in every one of the other countries.
Those who oppose change continue to insist that our system offers choice, yet insurance company physician networks continue to contract, and for a large number of people, the dominant choice is between paying enormous out-of-pocket expenses or forgoing care.
Many people believe our system is primarily privately financed, but taxpayers already support much of this costly system (including Congress’ health care) with huge subsidies in the form of tax breaks to private employers for providing health coverage to their employees. Why are costs so high in our country?
There are many reasons, some of which the Affordable Care Act attempted to address, such as limiting the administrative costs of large private insurance companies to less than 15 percent of total premiums. But the fact is, after three years, careful maneuvering by these companies has kept their administrative and profit margins at nearly 17 percent, unchanged from 2012. For comparison, this is six times the administrative cost of the traditional Medicare program.
A great many people continue to believe that universal, single-payer health care is a pipe dream that could never be implemented in our country. Apologists for the status quo are now pointing at the recent attempt by Vermont to create “Green Mountain Care.” However, this was a hybrid of single payer and the many government and privately funded insurance programs that already existed in the state, and not a true single-payer system for the entire population of the state.
While the Affordable Care Act improves health care access for many, its provisions actually make it more difficult for an individual state to enact a true single-payer system. Furthermore, even the most pessimistic projections for this complex compromise would have resulted, by expert estimates, in $500 million in annual cost savings — not a trivial amount in a small state with an annual health care budget approaching $2 billion.
We need to stand up for Medicare, and the huge social benefit our society has reaped from the program, especially for the vulnerable elderly. Moving forward, we need to expand that social benefit to other vulnerable populations, and to each other, to keep our nation healthy and economically competitive.
Dr. David Ray is chairman of the Capital Region chapter of Physicians for a National Health Program. The chapter is sponsoring a talk on the idea of a single-payer health care system at 7 p.m. April 20 at the SUNY School of Public Health at the University at Albany. The speaker will be Dr. David Himmelstein, a professor at the City University of New York School of Public Health, and an expert on the economics and practicality of national single-payer health care.