By Hedda Haning
The Charleston Gazette
August 12, 2007
Three commentaries in the Aug. 5 Sunday Gazette-Mail related to the costs of medical care in the United States — one on children’s coverage, one on the negative effects on business and one reporting the negative effects of privatization on Medicare. But the most stunning demonstration that the system is broken was the article describing a Florida couple receiving nursing home care in India.
In the 1930s FDR’s original Social Security legislation included medical coverage, modeled on European programs of the time. The AMA fought the medical part vigorously. Not wanting to risk his entire program, FDR removed medical insurance from the plan.
During World War II, wages were controlled, and employers, trying to attract workers in a tight labor market, added medical insurance to wages as an inducement. The strategy worked. Thus was medical insurance linked to employment. It was really a pragmatic accident of the times, rather than the result of studious deliberation.
Which brings us to where we are now. Because of major advances in science and technology, medicine has much more to offer us, and it is now an expensive necessity rather than an optional nicety. Many jobs have been outsourced. Few jobs last a lifetime. The labor market is not tight, so employers don’t need benefits to attract workers. The result is that far fewer people have coverage through their work. And the self-employed have always had to finance their own care, all while costs are climbing far faster than inflation.
Co-payments and deductibles raise consumers’ out-of-pocket costs substantially higher. Claims are denied. Many insured do not get the care they need, and the uninsured are totally out in the cold, but often invisible to the community.
Furthermore, as Dr. Dan Foster mentioned, the high cost of privately insured health care is becoming an unsustainable burden for business. Plainly the system that worked in World War II and through the 1980s is not working now.
Contrary to President Bush’s assertion, desperately getting emergency help is not equivalent to having dependable, readily available health care. Everyone agrees we have a problem. The solution is in contention. The favorite approach now is to help Americans buy into private insurance plans.
It is time for a reality check.
Private insurers are in business to make a profit for their stockholders. For most companies, 30 percent of premiums go to administration, marketing and profits. Private insurers have an incentive to hold down their own costs and increase their profits. They have no incentive to hold down subscriber costs or improve subscriber care, both of which would cut into profits.
Perhaps we should use our experience with safety services, schools, libraries and roads to suggest a solution. First, concentrate on care, not insurance. Insurance is only one route toward paying for health care. All health care should be:
* Universal and equitable — the same care available to everyone, including Congress.
* Unaffected by employment status, pre-existing conditions or ability to pay.
* Comprehensive, covering all medically necessary expenses including primary care, medications, procedures, hospitalizations, mental health, dental, nursing home and home health care.
* Non-profit, a regulated public service.
* Totally paid for from tax-supported public funds with no co-payments and no deductibles.
* Portable throughout the United States.
You would continue to choose your own doctor and hospital. The difference is in the payment system. Payments to providers and hospitals would come from a single payer, an agency local enough to be workable, such as representing a single state or a group of states. Without paperwork for each visit, administrative costs would be greatly reduced.
A single system can better assess the application of new technology and quality of care outcomes, and regulate medication quality and cost. Since we would all be in the same boat, we would all have an incentive to fix the problems that will surely arise.
Furthermore, preventive and primary care could become the priority they should be. That would include paying for all children to have routine exams and immunizations.
Most people don’t know that the federal government already pays for two-thirds of health-care costs through programs including Medicare, Medicaid, the military and tax breaks. The federal government already pays — right now — more per capita for health care than other developed nations pay.
Some think that the most important goal is to protect private insurance company profits. That is why the attempt is being made to privatize Medicare in spite of demonstrable increased cost and poorer performance.
You’ve heard the argument against this proposal: “not politically feasible,” which means the insurance and pharmaceutical companies don’t like it.
Yet most primary-care physicians support such a program, as do numerous medically affiliated professionals, unions and non-profit organizations. Doctors in other capitalist countries are quite positive about their own single-payer systems, as are the patients they serve. They do research, develop and use new drugs, and have access to more advanced technology than we do. They have less interference with their medical decisions than our doctors. And their health outcomes are better than ours, all while keeping health care reasonably affordable.
Perhaps it’s un-American? Still polls show that two-thirds of Americans support such a program, even if they have to pay more in taxes to get it, which would still cost less than paying for private insurance. Single payer is the only feasible plan.
Of course there are details to be worked out, but we are in serious trouble here. Other developed countries have succeeded in providing better health care than we do for half the cost. Aren’t we as smart as they are?
Haning is an anesthesiologist and a member of the Mountain State Physicians for a National Health Program.
