EXECUTIVE SUMMARY
(the full report can be found at http://www.healthreformprogram.org/)
This report finds that complete, comprehensive health care for all Rhode Islanders is already affordable.
Complete care means coverage for people who lack insurance coverage today.
Comprehensive care means thorough insurance for prescription drugs, dental care, and other services that are omitted from many insurance policies today.
Why is complete and comprehensive health care for all Rhode Islanders affordable today? For two main reasons:
The money is already available. Current health care spending in Rhode Island is fourth-highest in the nation, 21.5 percent above the U.S. average. And U.S. average spending per person is itself more double the western European average. Those nations cover all citizens and enjoy better health outcomes than do Americans.
Cutting administrative waste, cutting drug prices, acting to prevent some medical problems, and other efficiencies save enough money to finance full insurance coverage for people who are now uninsured or inadequately insured.
This report finds that the three main alternatives to health care for all are themselves unaffordable. These alternatives are more money for business as usual (without improving coverage), efforts to cover more people with band-aid additions, and efforts to cut health costs by cutting insurance coverage or asking families to pay more.
This report estimates the costs of universal health care in Rhode Island and contrasts those costs with a continuation of the current system. It shows that universal health care for the people of Rhode Island is affordable. It offers alarming new evidence that ever-higher spending for business-as-usual in Rhode Island health care is not sustainable for people who pay for it or for people who use it, and that business-as-usual is cheating the state�s people by wasting huge sums on the private sector�s payment bureaucracy at the expense of the care that all Rhode Islanders need.
Consolidated financing is essential to cutting administrative costs. (And cutting those administrative costs is essential to financing comprehensive health care for all.) Financing can be consolidated in one of two ways.
The first is the simple single payer approach. Here, private insurance simply ends, out-of-pocket payments are virtually eliminated, and taxes are raised to replace the lost revenue. This means big tax increases.
The second is to pool all revenues in one reservoir, which allows the same administrative savings as single payer but requires much smaller tax increases. This has the advantage of capturing dollars now paid through private health insurance by employers and employees. Today�s private insurance payments are frozen in today�s dollars. Checks are written to a new health care trust fund, not to private insurers. Increased health costs in future years are covered by public spending. This means much smaller tax increases.
Consolidated financing alone is essential to financing comprehensive health care for all Rhode Islanders today. Looking ahead, though, it is not enough�by itself�to ensure affordable medical security for years ahead.
That is because health care costs continue to increase as the population ages and as costly new medical advances are made�things like expensive new drugs, surgical treatments, and transplants.
But what good are these medical advances if Rhode Islanders can�t afford them? Rhode Islanders deserve medical security. This first requires deciding what �medical security� really means. It then requires making sure that we shape health care�delivery and financing�to reach this goal. If we don�t deliberately plan to succeed, we are surely planning to fail. And that would be a tragedy.
Ultimately, no state or nation can ever spend enough to win immortality for its citizens. So immortality is not the goal. Rather, the goal should be something like this:
All Rhode Islanders should be able to get the health care they need�high-quality health care that works�without having to worry about whether they can afford it.
Health care spending in the United States is vast. In the year 2000, health spending in the U.S.A. was more than four times as great as was spending on national defense. And spending in Rhode Island was 21.5 percent above the U.S. average, as noted earlier.
For the long haul, reaching the goal of affordable high-quality health care for all Rhode Islanders requires that we spend our vast but still finite health care dollars as carefully as possible. This requires going far beyond the simple but vital step of consolidating financing.
It requires that doctors, hospitals, and other caregivers be paid in financially neutral ways�in ways that encourage, liberate, and require them to spend money as carefully as possible. This means, certainly, that all needed caregivers be paid enough money to allow them to remain open in Rhode Island�as long as they operate efficiently.
It requires, further, that doctors�who make the key decisions about how the great bulk of health care dollars are spent�are particularly empowered to spend our money carefully. This should begin by recognizing that doctors traditionally get about one-fifth of the health care dollar. They should be assured this money, to be divided up among them in reasonable proportion to competence, kindness, effort, and other factors.
But doctors also should be encouraged, liberated, and required to marshal the bulk of the remaining 80 percent of the money (excepting only dollars needed by dentists, public health agencies, researchers, and other independent actors) to provide the care that all Rhode Islanders need. Doctors would have to spend all of that money on their patients, and could not spend more. They could not personally benefit by economizing on care. This approach encourages patients and payers to trust doctors� decisions.
This has been called �professionalism within a budget.� It is one sensible way to balance the books in health care. If any patient is denied a service because it would be of small benefit to them, the aim would not be to enrich a physician or a for-profit HMO. Rather, the only reason for denying a service would be to make that service available to another patient who needed it more.
This is nothing more than spending money carefully�of getting as much health care as possible to the people who need it. This is nothing more than recognizing that all Rhode Islanders need health care but that dollars are always going to be limited. This is nothing more than a way to build trust in Rhode Island health care that offers medical security�durably affordable medical security�to all residents.
We offer this report in the hope that it will help the public and policy-makers to grapple with the complexity of our health care system, and to identify the benefits of universal access to comprehensive care with simplified administration.
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The American Medical Student Association (AMSA) is pleased to cite a report to the Rhode Island General Assembly proving that a single-payer universal health care system would save the state $270 million in health care costs. AMSA, the nation�s largest independent organization of physicians-in-training, believes that equal access to comprehensive health care is a basic human right. AMSA has supported single-payer national health insurance as a solution to the nation�s crumbling health care system since 1989. The AMSA Foundation�s 2002 American Health Care System Survey found that an overwhelming majority of first and fourth year medicals students believe that health care is a right.
�Healthcare is an issue that touches every American, regardless of age, race, or gender. Quality health care for all people through a single-payer system would help end the dramatic disparities that continue as long as we consider health care a privilege for those who can afford it,� says AMSA National President Eric J. Hodgson, M.D.
The results of the Rhode Island study conducted by Alan Sager, Ph.D., of Boston University School of Public Health�s Health Reform Program found that the state could provide, with a savings of 3.6%, complete care to its 75,000 uninsured residents and comprehensive care for residents currently with insurance but lacking coverage for prescription drugs, dental care, and other services.
The Rhode Island study is the latest to confirm that single-payer reform is not only a feasible solution, but also one that is more favorable than other, incremental approaches. The study comes a week after former Vice President Al Gore announced that he favors single-payer national health insurance as a solution to the health care crisis. AMSA supports Mr. Gore�s statement as a way to re-ignite the debate on needed health reform.
On November 18, four former Secretaries of Health & Human Services and former Surgeon General David Satcher described the nation�s health system as �too costly, inefficient, [and] unfair,� and in need of an �overhaul.� (Toner, Atlanta Journal-Constitution, 11/19) The Rhode Island study shows that such an overhaul is possible with a single-payer system, providing health insurance to the uninsured and to those with insufficient coverage. The study coincides with a report from the Institute of Medicine calling for 3-5 states to begin demonstration projects providing universal health care.
Earlier this year, the AMSA Foundation conducted the first-ever study of medical student knowledge and attitudes of issues surrounding universal health care and health disparities. The study found that about 90% of first and fourth year medical students agree that every American is entitled to adequate medical care regardless of ability to pay. A majority of students believe that some form of a universal heath care system would provide the best health care to the most people for the least amount of money.