By Jack Bernard
Like the Dew, August 7, 2019
“For every $1 increase in taxes, we’re talking about more savings through getting rid of premiums, copays, and deductibles. So overall people would do better, and more importantly they would never need to worry about not getting the care that they need.”
– Adam Gaffney, M.D. (President, Physicians for a National Health Plan, on Medicare for All)
The Governor of North Carolina is working hard to get Medicaid expansion approved. And, his efforts should be commended: 40,000 good paying new jobs and an additional half million state residents with insurance, which will also have a positive effect on financially hard pressed NC hospitals which are now writing off medically uninsured as bad debt.
However, Medicaid expansion only a stop gap measure. As someone with an extensive health policy background who has researched and written about the topic in newspapers around the nation, I agree 100% with Dr. Gaffney regarding Medicare for All. Single payer is not only a moral imperative and completely feasible, it is the only way to control our nation’s runaway health expenditures.
I’m a confirmed capitalist. I’ve been a VP or SVP for several large for-profit healthcare firms. Generally, private enterprise is more efficient than government.
However, the exception to the rule is healthcare financing. Medicare’s overhead is 2% versus 12% for the for-profit insurance companies.
Repeated OECD (Organization for Economic Co-operation and Development) analyses illustrate that we pay much more per capita than any other affluent democracy for healthcare… each year, every year. For example, France is considered to have the best healthcare system in the world while we are 37th (WHO, 2000). Yet, France’s 2017 per capita expenditures were $4902. Our per capita health expenditures were $10,209…over double theirs.
And it’s not just France; all developed nations have greater involvement of government in their healthcare financing systems versus here and all cover 100% of their citizens at a much lower per capita cost than here. For example, here are per capita costs for other democracies: Israel-$2833; New Zealand- $3,682; Australia- $4543; Canada- $4826; and Denmark- $5182.
Part of the reason for the difference in cost is our emphasis on private insurance companies. Clearly, single payer is the ultimate solution… but is opposed by the massive and influential healthcare industrial complex for obvious self-interested reasons. Therefore, insurance companies and drug companies…assisted by the outrageous SCOTUS decision in Citizens United permitting “dark money” …are spending tens of millions to prevent Medicare for All, which would cut their obscene profits as well as ridiculous executive compensation.
One of the fallacies these companies and their lobbyists perpetuate is that we are more expensive due to better quality here. Yet, healthcare outcomes in the USA (as measured by mortality and morbidity statistics) are worse than other democracies.
A recent study analyzed quality, access, efficiency, equity, general health among 7 developed nations (US, Canada, New Zealand, Germany, Australia, UK and the Netherlands). We ranked last (Commonwealth Fund, 2010).
Yes, this is partially due to our unique American life style (lots of guns, fast cars, etc.). But a large part of the difference is because many of our states have high proportions of uninsured. They are getting inferior care, causing unnecessary death and disease.
For example, our maternal deaths are much higher than other advanced nations (ProPublica, 5-12-17). Per the ProPublica study, “60 percent of such deaths were preventable”.
Infant deaths are another example of poor outcomes here versus every other advanced nation. Our national rate of death per 1000 live births is 5.8, as opposed to much lower rates in other democracies: Israel- 3.0; Italy- 3.0; France-3.5; UK-3.8. (World Bank data, 2015)
Rates vary among states. Per the CDC (2017), North Carolina has a 9/1000 live births infant mortality rate. Our rate is worse than Uruguay, Lebanon, Romania, Bulgaria, Chile, Albania and so on.
National infant mortality rates here vary widely by race/ethnicity: Non-Hispanic black: 11.4; Hispanics:5.0 and Non-Hispanic white: 4.9. To give you a reference point, the deaths per thousand for Black infants in the USA is worse than Turkey, Peru, Libya, Thailand and so forth.
How the most religious democracy in the world (Pew, 7-31-18) can justify letting its citizens go without needed care is beyond reasoning. Helping the unfortunate is supposed to be a basis of Judeo-Christian doctrine. How can we as a nation be content and just ignore this level of hypocrisy?
Single payer is not only right morally, it’s right from an efficiency and quality standpoint. However, it will not happen unless two things occur: a. the Democratic Party presents a unified block in supporting true Medicare for All (as the debates showed, they are not yet there) and b. what’s left of the GOP moderates in Congress finally have the courage to do what is right versus playing to their base (an even tougher fight). Our citizenry must pressure both parties now, not later.
Jack A Bernard is a retired SVP with a national healthcare corporation. He was Chair of the Jasper County, Ga. Board of Commissioners and Republican Party. He was also on the Board of Health for Jasper County and is currently on the Fayette County BOH. Bernard has over 100 columns published annually, primarily in the South.
