Effective, efficient health care for everyone
By Ivan Imm, guest columnist
Published Wednesday, March 29, 2006
Winona Daily News
Our health care system in America is broken and in crisis. Millions of hard-working Americans have no health insurance, and those who have it are paying more every year for poorer coverage and higher deductibles. Last fall, I wrote a column describing a simple, workable solution to this crisis. Called “single-payer” health care, it would provide health insurance to every person in America.
Medicare is a “single-payer” system already in place. Those older than 65 visit the doctor of their choice, and the government (the “single-payer”) pays that doctor. It’s simple. No insurance companies are involved; no HMO bureaucrat is telling you what’s not covered or what doctor you can or can’t see.
That’s the way a national, universal single-payer health system would work. Also known as “Medicare-for-All,” it would extend this Medicare model to cover every American, regardless of age. But is Medicare a good enough program to extend to the entire population? Let’s take a look.
Most anyone enrolled in Medicare will tell you that it is a well-run, efficient system, and that they are generally quite satisfied with it. The one exception to this is Part-D, the new drug-coverage portion of Medicare.
Medicare is lean and efficient. Its administrative costs are 3 percent. This means that for every dollar we put into it, only 3 cents goes toward paperwork, salaries and other overhead.
Let’s compare that with the health care situation we who are younger than 65 are saddled with. For every dollar we put into the current non-Medicare system, 30 cents is used up by overhead. That’s not surprising, when you think about all the costs involved: legions of paper-pushers handling millions of billing statements, people hired to second-guess and hamstring your doctor in how she can treat you, rules and regulations on what providers you can use.
The man who directs the entire Medicare program is paid about $140,000 a year, whereas the total compensation of the top executive of a leading HMO over past two years was more than $120 million! That is truly obscene. Any wonder medical costs are shooting sky-high?
The fact that Medicare is well-run and efficient should be enough for us to support a move to extend it to all of us. What other positive benefits would there be?
Would strengthen business, schools
For one thing, changing to a Medicare-for-All system would strengthen American business. Most employers provide health insurance to their workers, but a growing number of small businesses cannot afford to continue offering their employees insurance. Even for behemoths such as Ford, GM and Northwest Airlines, the cost of health insurance is pricing them out of the market, and they are slashing the benefits they provide to their workers, as well as being forced to raise prices.
For another, a single-payer system can help assure the strength of our schools and local government services, both of which now are drowning in health care costs. It isn’t primarily the price of books or the salaries of teachers that is causing K-12 school systems to cut staff and programs. It is the cost of health care. With all of the money suddenly made available because it no longer had to pay for its employee health insurance, a school system would have much less need for referendums and bake sales.
Important questions
Is the quality of U.S. health care superior to that found in other countries?
How do the costs of U.S. health care compare with the cost in other countries?
Would Medicare for all be a clone of the system Canada uses?
How will research and development of new drugs be affected by such a change?
What exactly are “consumer-driven” health care and Health Savings Accounts?
Who benefits most from Health Savings Accounts?
Does the media perpetuate a “blame the victim” approach in discussing healthcare solutions?
Would a change to a single-payer happen all at once? Or in steps?
How would the middle-class be affected by adoption of single-payer?
Is there anything an average citizen can do to help change our health care system for the better?
I’ll tackle these questions in my final couple of columns on health care.
Ivan Imm served as director of public health planning units and public health programs for the state of Wisconsin, served on the board of the Wisconsin Consortium for Primary Care and was vice chairman of the Wisconsin Statewide Healthcare Workforce Forum. He has been a member of the Minnesota State College and University System Health Education Industry Partnership Council and is a health care consultant to the MnSCU system. He can be reached at imm3944@acegroup.cc.
Guest views are opinions of the author and don’t necessarily reflect the views of the Winona Daily News. They are published to stimulate thought and to provide an expanded forum on issues of local interest.