Atlanta Journal Constitution
Editorial
Health care system needs doctoring
Published on: 04/24/04
The American health care system is in some ways like the Titanic. It is big and luxurious and a showplace for the last word in technology. It is committed to its clientele, especially those in the upper decks. Many of the people bidding the ocean liner farewell from the shore wish that they could come aboard, but even though they work hard, sometimes holding down two jobs at a time, they just can’t afford it.
Our titanic medical delivery system is the envy of the world, embraced and patronized by kings and potentates. Surely its future is guaranteed.
Or is it?
Critics of our $1.6 trillion health care industry warn of real trouble ahead. We spend more per capita than any nation in the world, yet the CIA World Fact Book rates us 48th in life expectancy, compared to 11th for neighboring Canada. We annually squander some $135 billion in lost productivity due to illness, much of it preventable, and an estimated 15 percent of our population — some 43.6 million people — lived without health insurance for all of 2002. According to Census Bureau figures, 25.6 million of those without insurance worked either part time or full time.
But the truly big iceberg looming dead ahead is the rising cost of health care, including prescription drugs and hospital care. That is driving some employers to drop job-related health insurance, and is putting others at a serious disadvantage with foreign competitors that do not have to cover health insurance costs for their employees.
In the fierce, globally competitive auto industry, for instance, accountants estimate that health insurance costs for U.S. manufacturers add $1,300 to the price of each vehicle, even more than the cost of steel. European manufacturers, in contrast, often benefit from government health insurance plans that keep companies off the hook. The lure of avoiding health insurance costs also helps account for the outsourcing of jobs overseas.
Technology also poses a threat to the current U.S. health care system. Genetic research, for example, may soon identify which of us are prone to certain diseases, thereby making preventive care possible. But it will also help insurance companies identify which of us are at higher risk of illnesses that threaten to be chronic and even catastrophic, allowing the companies to deny coverage for those people. After all, as one traditional insurance source put it, “We are not in the habit of insuring burning houses.”
A decade ago, the Clinton administration made a well-intended but poorly handled bid to introduce universal, single-payer coverage, an effort that ended in political disaster for Democrats and took the issue off the national agenda. The passage of time, however, has only confirmed the initial attractions of that approach. In a lengthy piece in the April 18 New York Times Sunday Magazine, former first lady Hillary Clinton, now a U.S. senator from New York, argues for an overall system that pools risk and directs funds to a comprehensive plan that takes care of health needs and focuses on health maintenance.
Such a plan could focus on efficiencies of delivery and mandate research on illnesses that are neglected because the numbers of the sick are small” for instance, serious diseases such as epilepsy and killers such as scleroderma. A managed health care program could also guide and finance research into overarching health problems such as asthma and other pulmonary diseases.
Inevitably, a single-payer system would create challenges of its own, and may not be the ultimate answer. But the business community that bitterly opposed the concept a decade ago is now beginning to see financial merits in the approach. Doctors, hospitals and patients struggling to deal with an ever-more complex private insurance scheme may prove more open to the idea as well. And the inescapable truth is that for all of its technology and know-how, the United States gets less cure for its health care buck than any other highly advanced nation.
Surely that’s sufficient cause to rethink what we’ve been doing.
LIFE EXPECTANCY
The United States ranks 48th out of 225 countries surveyed.