By Margaret Flowers
The Charlotte Observer
Thursday, Nov. 18, 2010
It’s been said that a society can be judged by how it treats its most vulnerable. If that’s the case, what can we say about today’s United States?
I recently toured several cities in North Carolina to speak about national health insurance. I had the pleasure of meeting with physicians, health advocates and citizens from all walks of life.
Many of the physicians I met are working in health centers that treat the uninsured. While such efforts are important and commendable, the doctors are saying that they are unable to meet the growing need.
The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. In North Carolina, about 1.7 million – nearly 1 in 5 residents – lacked coverage last year. That’s 300,000 more than the year before. Much of the increase, of course, can be chalked up to job losses.
Lack of insurance fatal for many
We know that people who lack insurance suffer much more than their insured counterparts. They also more frequently die of preventable causes. A recent study in the American Journal of Public Health, for example, shows about 45,000 deaths annually can be linked to lack of health insurance. That’s about 120 preventable deaths a day.
And then there’s the problem of underinsurance – people having poor-quality insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These onerous “cost sharing” measures are obstacles to getting care. The gaps in such policies can easily lead to personal bankruptcy in the event of serious illness.
Sadly, the new federal health law falls short of the remedy we need.
Most of the provisions in the legislation do not take effect until 2014. Thus, for the foreseeable future, literally tens of millions of Americans will remain uninsured. In fact, the Congressional Budget Office estimates that about 23 million people will still lack coverage in 2019. That’s a deadly scenario.
I’m a pediatrician, so I was particularly interested in two provisions in the federal bill relating to children that kicked in last month. One measure allows children under 26 to remain on their parents’ policies. While beneficial, this provision will expand coverage to only about 20 percent of the young adults who need it.
Insurors screen out the sick
Another measure would prevent health insurers from denying new policies to children with pre-existing conditions. However, just before it went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.
What can we conclude from these and similar episodes? As long as private insurers occupy a commanding role in our health system, we will never be able to achieve truly universal or affordable care. The insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums. They do not put patients’ interests first; they do not provide care.
And yet the new health law keeps the big insurers – the main obstacle to care – at the heart of our system.
There is a better alternative: a national health insurance program that is publicly financed and privately delivered. This solution is commonly referred to as improved Medicare for all. It’s supported by about two-thirds of the population and a solid majority of physicians, according to national surveys.
Make it Medicare for all
Improved Medicare for all would be truly universal – every person living in the United States would be guaranteed high-quality care from birth to death. People would no longer worry about losing coverage if they changed jobs or became unemployed. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions.
Patients would be able to go to any physician and any health facility of their choice, and decisions about treatment would be made by patients and their health professionals without interference by insurance company administrators.
By replacing our inefficient, dysfunctional patchwork of private insurers with a streamlined, single payer of all medical bills, much like Medicare operates today, our nation would save about $400 billion annually in reduced administrative costs.
That’s enough to cover everyone, with no co-pays or deductibles. We’d also acquire very strong cost-control tools like the ability to negotiate fees and purchase medications in bulk.
I urge you to learn more about the improved-Medicare-for-all approach to health care. Let’s be the great society that we have the potential to be.
Margaret Flowers, M.D., lives in Baltimore and is congressional fellow for Physicians for a National Health Program ( www.pnhp.org). She is also a board member of Healthcare-Now ( www.healthcare-now.org).
http://www.charlotteobserver.com/2010/11/18/1845659/new-health-law-falls-short.html