Michael Ozer
Special to the San Antonio Express-News
04/07/2007
When one examines the state of the U.S. health care system today, three things are obvious.
First is access. Forty-seven million people are uninsured, and demand for medical care has never been greater. Waiting lines are longer and emergency rooms are overflowing.
Second, our system of employer-financed insurance cannot meet the escalating crisis. Premiums and costs are higher than ever while coverage is increasingly skimpier.
Third, Americans have a growing desire to fix the system, and the majority seem to want a national fix. In a recent New York Times/CBS poll, nearly two-thirds of those surveyed said the government should guarantee coverage for all Americans. Half said they would be willing to pay up to $500 a year more in taxes for universal coverage.
So where does all this leave us? For one thing, it means the 2008 presidential candidates will be talking more about health care as their campaigns unfold, and, as consumers, we should try to better understand the underlying issues.
At this point, none of the major contenders has made bold proposals that would threaten the dominant role the private insurers have in our system. Most would create mandates for employers to purchase health insurance for their employees and provide tax credits for those too rich to qualify for Medicaid or the Children’s Health Insurance Program.
Unfortunately, such approaches won’t adequately address the problem. Decent coverage would increasingly become more unaffordable for more and more Americans as medical costs continue to rise.
In Massachusetts, the pioneer of the state-mandated plans, a 56-year-old making $30,000 annually will have to spend $7,164 in premium and deductible payments before insurance kicks in and still pony up 20 percent of hospital costs after that, according to Physicians for A National Health Program, or PNHP.
Such coverage is health insurance in name only. It leaves patients unable to access care and subject to financial ruin. PNHP studies show that more than a quarter of insured Americans go without needed care because of cost, and 75 percent of those bankrupted by medical bills had coverage when they got sick.
Forcing or enticing Americans to buy stripped-down health insurance may decrease the number labeled “uninsured,” but it won’t protect the physical or financial health of beleaguered families. And as costs continue to rise, employers will push more middle-class families from comprehensive plans into ones with scaled-down benefits and higher deductibles.
The only way to simultaneously expand coverage and lower costs is through single-payer national health insurance, or NHI — a plan similar to Canada’s or Britain’s, but distinctly American in its approach.
There’s already federal legislation before Congress — the United States National Health Insurance Act (HR 676). It has 78 sponsors and would expand and improve the existing Medicare system, creating a sort of “Medicare for All.” Unfortunately, none of our local legislators have signed on yet.
Arguments that NHI would hurt medical research or lessen the quality of medical care are unfounded in this nation, with the existing personnel, resources and infrastructure devoted to health care. But we could achieve tremendous savings from overhead and duplication in our system, possibly as much as $350 billion a year, according to the New England Journal of Medicine.
In fact, PNHP estimates, U.S. insurance companies spend more than a third of U.S. health care dollars on administration and marketing as they try to enroll healthier, more profitable patients and sustain their profits. This diverts money that could be devoted to patient care. In addition, a national system would facilitate long-term cost controls on the pharmaceutical industry and in other areas, thus ensuring that the new benefits are sustainable.
And while a uniquely American single-payer system is the way to go, look for the insurance and pharmaceutical industries to fight intensely to stop it.
Health care affects every American, and all of us should educate ourselves on health care reforms. Inform your congressman where you stand on the issue.
Dr. Michael Ozer is a San Antonio pediatrician and a member of Physicians for A National Health Program.
