By Morolake Amole
AMSA ‘On Call’ blog, Aug. 13, 2014
The problem with health care in the United States is not that we suffer from inadequate medical resources. Quite the contrary.
We have thousands of highly skilled and dedicated doctors and nurses. We have many top-notch hospitals possessing state-of-the-art equipment and medications. We have significant patient protection laws.
So then how do we explain our country’s poor health outcomes, e.g. that we ranked 19th out of 19 wealthy nations in 2010 on preventing deaths that could have been avoided with medical care?
Here’s a clue: If you compare the U.S. system with those of other industrialized nations, you’ll see that no other country relies so heavily on multiple private insurance plans and has such high financial barriers to care.
Does the Affordable Care Act change this picture? The ACA will, within a few years, increase coverage for about 20 million people through a combination of subsidies for private insurance and an expansion of the Medicaid program (in those states that have agreed to accept it). This increased coverage will likely save many thousands of lives each year.
Yet even when the ACA is fully implemented, 30 million Americans will remain uninsured. Some won’t be able afford a private plan. A recent survey by Kaiser Family Foundation found that 36 percent of Americans between the ages of 18-64 who remain uninsured stated that they opted out of buying insurance because the plans available were too expensive.
Many million more will remain “under-insured,” i.e. vulnerable to severe financial stress if they get sick because they’re enrolled in skimpy health plans with high deductibles and co-pays.
The U.S. health care system is the most expensive in the world. In 2012, our nation spent roughly $2.8 trillion on health care, about $8,508 per person. Yet the ACA has no proven ways to control costs.
So, if the Affordable Care Act is not the final answer, what is?
Many physicians and economists believe that the answer lies in the adoption of a single-payer system. Such a system has already proven successful in Canada, where most care is taxpayer financed but delivered by private doctors and hospitals. One could cite a dozen other examples, from Norway to Taiwan.
Citizens of these nations enjoy high-quality health care, with outcomes that are generally as good as or better than ours – at much lower cost. They’re successful for a variety of reasons.
By establishing a payment system in which citizens pay taxes that are then designated toward health care, there’s an implied idea of transparency in health care spending. Citizens can see how their money is being spent.
Their systems have very low administrative costs, allowing them to spend more resources on providing actual health care. Single-payer systems are also better at controlling costs. They can buy drugs and medical supplies in bulk, and efficiently plan big capital outlays.
Nonprofit single-payer systems take away the power of private insurance companies to come between patients and their doctors. Patients no longer have to look to insurance agents for decisions on health matters, and patients can choose to go to whatever doctor or hospital they want.
And because patients are able to obtain primary care and receive treatment for problems at an earlier stage, they require fewer costly interventions later.
With a single-payer system in the U.S., physicians would be able to concentrate much more on what they were trained to do, and be less burdened with time-consuming and costly insurance paperwork. They’d remain well-compensated (e.g. Canada’s physicians have incomes comparable to their U.S. counterparts, especially when you factor in how little they have to lay out in overhead and malpractice), but primary care physicians would see their incomes rise, reflecting the crucial role they play.
The most important reason for enacting a single-payer national health insurance program, or an “improved Medicare for all,” is that it would achieve the goal of giving everyone equitable access to all medically necessary care. Health care would be re-routed toward its original goal of giving people an improved quality of life.
We should implement a nonprofit single-payer system without delay.
Morolake Amole is a clinical medical student at Meharry Medical College in Nashville.