By Robert Zarr MD, MPH, FAAP
American Academy of Pediatrics
Section of Young Physicians
Letters
Newsletter, Spring, 2008
I think the most important part of Hirotaka Yamashiro’s “Children and Single Payer Health Care: Pros and Cons,” was the comment about equity of care. Although it is important to discuss pediatrician’s relatively low reimbursement rates, more important is that America’s children receive quality care without bankrupting their families. Let’s not forget that we still have 9 million children without health insurance. These 9 million children forego necessary care, and suffer unnecessarily because of it. There is no doubt that the average Canadian child has better access to primary care than his/her American counterpart. The Canadian pediatrician, with lower office overhead, either specialist or primary care, is reimbursed with fewer hassles and more timely than his/her American counterpart. I would posit that what Canada has IS a good system that is under-funded. Canada’s neighbor to the South, in contrast, has a terribly wasteful and dysfunctional system with the largest private health insurance bureaucracy in the world. Our problem is not that we spend too little, but that we have no system. America spends twice as much per capita on health care as Canada, yet we have generally worse health outcomes. Currently more than 60% of US total health expenditures is publicly financed, and this amount is more than most developed countries spend total. Americans already pay for health care, but just don’t get it. Every developed country in the world, except the US, has government assured health insurance. Most spend half of what we do. Falling at number 37 in health outcomes, according to the World Health Organization, seems to suggest that the US has much to learn from other countries, and not vice versa. While every other developed country’s health care system most certainly has areas for improvement, none is in such a crisis as ours. We need a publicly financed but privately delivered health care system, which would be more equitable to all American children and their pediatricians. What we need in the US is single payer “American style.”