Measure 23 (Health Care for All) died an ignominious death on Nov. 5, but the health care crisis is still with us. The Oregon Health Plan’s future is uncertain and nearly half a million Oregonians are uninsured, including many low-wage workers. Many more are underinsured and struggling to pay exorbitant premiums. On a national level, moderate Sen. John Breaux of Louisiana declares that U.S. health care is “collapsing around us”. The horror stories that volunteers for Measure 23 heard during the campaign are remembered. But where do we go from here?
Americans spend far more on health care than other developed countries. Yet, the U.S. ranks only thirty-seventh in quality, according to the World Health Organization. Employer-based health care greatly increases labor costs, holds down wages, and keeps employees tied to particular jobs. U.S. health care costs are distributed through premiums, employer benefits, out-of-pocket expenses, and TAXES, so that the full cost is not appreciated. Our taxes pay for 60 percent of U.S. health care, while the Canadian government pays for 70 percent of Canadian health care. We are paying for a national health care system, but not receiving it.
Congress seems committed to “incrementalism” – just covering children, the needy, prescription drugs for the elderly, etc. From a cost-control viewpoint alone, two things are wrong with our piecemeal approach. First, as long as the uninsured are increasing and not getting preventive care, rising costs will be shifted to the insured. Restricting health care has contributed to the double-digit inflation in health care premiums. In any insurance plan, the larger the risk pool, the smaller the cost for the individual. Therefore, cost-effective health care will start with universal coverage. Second, the huge administrative costs of the insurance companies must be eliminated. Health care as a public service does not fit a profit-driven system. Administrative costs of a single-payer (government-insured) health care system are typically one-fifth that of a U.S. insurance company. Additionally, a national plan (as opposed to state-wide) eases the burden on small states and eliminates the migration argument.
The General Accounting Office has determined that single-payer national health care is the most cost-effective method of health care delivery that maintains providers in the private sector. It is no stranger to the U.S. Medicare was originally conceived as a single-payer system but is presently filtered through many insurance companies, adding to the complexity, expense, and diminishing coverage.
While the benefits of national health insurance are clear, many obstacles stand in the way. Americans must be persuaded that under such a system, provider choice would expand, not diminish, and that quality need not be sacrificed. The feeling that government cannot properly administer any public service is an American conviction, in spite of the popularity of Social Security, Medicare, Medicaid, an excellent military, and the fact that over 90% of Americans are publicly educated.
Where does health care reform go from here? A simplified state-wide initiative might be attempted to keep the issue alive. More Americans must be registered to vote so that they can support reform-minded candidates. Support the Wyden-Hatch Act and other legislation that will be introduced in 2003. In the meantime, let’s keep talking.
(Roberta Palmer, M.D., of Tigard is a member of Physicians for a National Health Program.)