By James Fieseher, M.D.
Concord (N.H.) Monitor, Feb. 10, 2015
As much as we’ve prospered as a nation under the “free market” system, one size doesn’t fit all. There are just some things that don’t belong in a free-market system, particularly when it comes to an integration of services.
For example, our national security is a government-run system that integrates a standing Army, Navy, Air Force, Marine Corps and Coast Guard. Outsourcing our military would create competing networks that would drive up costs and lose the efficiency of a coordinated military campaign. Similar arguments can be made for our police and firefighting departments.
Modern medicine now requires a system of integration that rivals our military. Coordination of care is now an integral part of our medical process, whether we’re fighting infection, cancer, mental illness or the ravages of aging.
Yet, there are many in this country and this state who insist it’s okay to buy and sell health care. “That’s different,” they say. “You can live without health insurance.”
Maybe we can’t. Last year, more than 48,000 Americans died unnecessarily because they couldn’t get health care in a timely manner. More than 100 of those were from New Hampshire. Of the 1.7 million Americans who filed for bankruptcy last year, more than 60 percent of them were due to medical expenses. Finally, which of us, when confronted with a loved one with a terminal disease, wouldn’t give everything we had to get their loved one’s health back? Without some type of health insurance, what are our chances?
The fact remains, our health is the most precious and personal thing we have. So why should our health care be bought and sold on the free market?
It shouldn’t. If the ethical argument doesn’t convince you, the fiscal argument should. The United States has had “free market” health insurance since the early 1970s. In 1980, health care spending accounted for 9 percent of our GDP, which was comparable to other industrialized nations. By 2008, health care spending rose to 16 percent and in the last seven years it now stands at 18 percent of our GDP. This means that the cost of health care isn’t just rising, the rate of growth is increasing as well.
If we don’t find a different solution to free-market health care, then the cost of health care will price itself out of that market.
There is one free market where health care does belong: the free market of ideas. We need to change our mode of thinking about health care. We should think about our health care as it was intended: a right for all Americans, not a commodity to be bought or sold.
Currently, there is a bill before the state Legislature (HB 686) sponsored by Reps. Richard McNamara, Suzanne Smith and Marcia Moody to bring a single-payer system of health care to New Hampshire. The bill was written by a group of New Hampshire physicians who are part of a national organization: Physicians for a National Health Program. PNHP represents a growing trend among health care providers (not just doctors, but nurse practitioners, nurses, physician assistants, etc.) who have firsthand knowledge of how badly the free market and for-profit motive is hampering the effectiveness of our health care system.
Single payer is the general system of care controlled either directly through the government or indirectly through government oversight. Single-payer health care is universal, meaning all residents have it, and comprehensive, meaning it reasonably covers most health problems and is affordable.
All other industrialized nations have a form of a single-payer system, and most of them have health care costs below 10 percent of their GDP (none are above 12 percent).
Is this the right time to bring a single-payer bill such as HB 686 before a Republican Legislature? The physicians of the New Hampshire chapter of PNHP think it is.
Health care is a bipartisan issue. No one political party has exclusive rights to it. The Affordable Care Act was passed without Republican participation and while it begins to address some aspects of our health care dilemma, it still relies on marketplace economics and hasn’t fulfilled the promise of meeting most of America’s health care needs.
HB 686 gives the Republicans an opportunity to take the leadership position on health care. The bill itself needs work in areas such as funding, which should enable the Republicans to put their fiscal stamp on such an important piece of legislation.
This year, we are seeing a trend in many Republican states where taxes are being raised to fulfill essential governmental services. If properly done, HB 686 should eliminate health insurance premiums across the board in exchange for a comparatively modest tax increase, a potential net savings of several billion dollars to businesses, individuals and the state.
It remains to be seen whether New Hampshire’s Republican-controlled Legislature will seize the opportunity to move forward in some manner with HB 686. It’s time for the party of Lincoln to emancipate our health care from the free market way of thinking.
Dr. James Fieseher is a primary care physician and lives in Dover.