By Dan Carpenter
Indianapolis Star
February 12, 2006
To prescribe health savings accounts for a medical system that’s the most overpriced, overcomplicated, underperforming and unfair in the developed world is an artless dodge that denies the possibility the real cure may already be in hand.
It’s called Medicare. It’s run by the government at an overhead rate of roughly 5 percent, compared to upwards of 25 percent for private insurance companies. It doesn’t waste a lot of resources evading payment of claims or driving undesirably sick people off the rolls. It offers pretty much all the choices anybody else does and boasts a high satisfaction rate. You don’t lose it when you lose your job or your employer loses market share.
Medicare, or single-payer insurance by its generic label, is so good that other capitalist nations offer it to everybody. And no, heart attack victims don’t die waiting for a cot. The industrialized world’s average per-capita spending on health care is less than half ours, and their results are better in category after category, from infant mortality to life expectancy to doctor visits.
Why does it work so well? Because it works differently from health savings accounts. Single-payer insurance operates with the widest possible risk pool, meaning the wealthiest and healthiest chip in to pick up the poorest and potentially sickest.
This means there’s enough money to provide routine/preventive attention to everyone, instead of leaving scores of millions to put off care until they die or seek highly expensive emergency care as welfare cases.
This means no wasting billions on advertising to compete for the least needy customers. This means fewer clerks getting paid to cull out the cancer patients and more funds to hire cancer treatment personnel. Not to mention fewer eight-figure bonuses to executives for raising rates and reducing claims.
It has to happen, says retired Indianapolis surgeon Chris Stack, who works with a single-payer advocacy group called Physicians for a National Health Program. “You have GM, Wal-Mart, plus the average guy making $50,000 working his (deleted) off with two kids — he’s getting screwed. This cuts across ideological lines.”
So why is President Bush proposing not to expand Medicare but to cut it, while offering tax incentives to those who can go out and buy their own health care with high premiums and high deductibles, thus shrinking the risk pool?
Vested interests, of course. That’s why they made a labyrinth of the Medicare drug component with Plan D, an epochal transfer of national wealth to corporations, which waste more than $100 million of our health resources a year in lobbying.
So, you have top-heavy politics abetting a top-heavy health care system. Why isn’t the public pushing back?
“It’s such a puzzle,” says Matthew Gutwein, president of Wishard Memorial Hospital. “There is general skepticism about government as a better alternative to the private market. It’s not true of health care that private is better.”
While Gutwein doesn’t oppose health savings accounts, he calls them a Band-Aid and sees signs all about that single-payer is inevitable. The United States, he says, can’t compete globally and remain the only nation that ties health care to the workplace and marketplace.
So husband your money and try a hospital-tested home remedy. “We love Medicare,” the Wishard head man says. The question grows ever more pressing: What’s not to love?
Carpenter is Star op-ed columnist. Contact him at (317) 444-6172 or at dan.carpenter@indystar.com.
