By MILES WEINBURGER
Des Moines Register
IOWA VIEW
April 26, 2007
We have in America outstanding health-care facilities, excellent doctors and world-class research. What we lack is the universal health-care coverage present in all other industrial nations that provides assurance that health care will be available to us when we need it.
Many of you reading this may say, “I’ve got good insurance that my employer provides.” Let’s hope your insurer stays in business and that you never have to change jobs or go into business for yourself.
Or if you do, hope that you don’t have asthma, high cholesterol, migraine or any kind of headaches, depression or anxiety disorders or the myriad of other common clinical problems that will either make you uninsurable, raise your rates or provide exclusions from coverage.
An article published in a 2005 issue of the Health Affairs journal reported that more than half of the almost 12,000 bankruptcies in Iowa were medically related, a ratio similar to the national average. Most of the people involved had health insurance of some kind, and less than 3 percent of those uninsured had been without insurance voluntarily.
Beneath the fog and rhetoric of the early stages of the presidential campaign, the main contenders for the presidency, other than Democrat Dennis Kucinich, are offering alternatives that preserve the inefficiencies and inequities of the current system. They don’t adequately consider the solutions that could most effectively eliminate the deficiencies that place all of us at risk for joining the one-third of Americans who are uninsured or underinsured.
The plans proposed by the spectrum of politicians fail because they concede to insurance firms a continuing dominant role in health care. The much-publicized plan for universal coverage in Massachusetts, for example, mandates all to buy insurance. However, 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, assuming no pre-existing conditions that would either increase costs further or exclude those conditions from coverage.
Such plans are insurance in name only. They leave people unable to get care and unprotected from financial ruin. The only way to simultaneously expand coverage and lower costs is through single-payer national health insurance. Every other developed nation has some form of this, yet most spend less than half what we do per person.
Nearly a third of our $2.3 trillion in health spending this year will go for administration. In their drive to enroll healthy, profitable patients and screen out the sick, private insurers waste vast sums on marketing, billing, underwriting, utilization review and other activities that sustain profits but divert resources from care. The paperwork they inflict on doctors and hospitals costs hundreds of billions more each year.
In contrast to the roughly 20 percent overhead of insurance companies, U.S. Medicare has only 3 percent overhead. Canada’s single-payer program runs for 1 percent overhead. And Canada’s hospitals and doctors face little paperwork burden.
Americans get scant return for our outsized spending. We already pay the highest health-care taxes in the world, and total per-capita spending is twice that of countries with better health outcomes. We already spend enough that the sum should cover universal health coverage – we just don’t get it.
Studies in the prestigious New England Journal of Medicine and elsewhere have shown that streamlining our health bureaucracy through a single public payer – a kind of “Improved Medicare for All” – would save enough new money to provide comprehensive benefits for all Americans.
We deserve better than we’re getting. A single-payer system is the only economically viable reform option that will serve us better as a nation. Yet opposition from insurance and drug-industry giants continues to intimidate lawmakers and aspirants to the presidency. It is time for our leaders to stand up for the health of the American people rather than the wealth of our richest firms.
Dr. MILES WEINBERGER is a professor of pediatrics at the University of Iowa.
