What to Do about
Health Care

Americans are living with first rate medicine and a third rate health care system, and the problem is getting worse instead of better. After all, what good are the latest medical technologies if half the population can’t gain access to them? The most critical problem to be solved with regard to health is how to create a delivery system that provides the benefits of 21st century medicine in a way that meets the test of a fair and decent society.

The available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal health coverage, the savings would be so large that we could cover all those who are currently uninsured, yet end up spending less overall. That’s what happened in Taiwan, which adopted a single-payer system in 1995; the percentage of the population with health insurance soared from 57% to 97%, yet health care costs actually grew more slowly than one would have predicted from trends before the change in the system.

In the United States, a mish-mash of private insurance companies, declining employer-provided insurance benefits, federally funded programs like Medicare and the Veteran’s Administration, and the federal-state matching program for the very poor known as Medicaid has caused health care expenses to rise so high that we actually spend twice as much on health care per person than Canada, France, and England. A large bulk of this is waste is in the form of bureaucratic administrative costs. The United States spends approximately 25% of its money on administration, compared with 2% for most countries with universal and standardized coverage. This is because private insurers incur high administrative expenses as they work hard to screen out unhealthy people in order to maximize profits.

There are many, many studies available on health care. I don’t want to recap the results of those studies in this position paper, but I strongly urge all of you to read the excellent analysis of both the problem and the solution by New York Times columnist Paul Krugman and Robin Wells in the March 23rd issue of the New York Review of Books, entitled “The Health Care Crisis and What To Do About It.” (Go to http://www.nybooks.com/articles/18802).

Two very effective health care delivery models already exist in America, but they provide care to only two specific groups of citizens: the first is Medicare, a program for senior citizens, and the second is the Veteran’s Administration, a program for veterans. Medicare and Veterans Administration programs are 100% federally funded. The Veterans Administration actually provides a system of socialized medicine because it employs its own doctors and runs its own hospitals and clinics. Most important, it provides some of the best quality health care in America with far lower administrative, pharmaceutical, and other costs than in the private sector. It’s extremely ironic that when a president has a health care issue, he goes to Walter Reed Army Hospital in Washington, D.C., and at this VA Hospital, run wholly by the government and staffed with government employed doctors, he receives the highest quality medical care!

We have been sold a bill of goods by the private insurance industry – namely that the government is not capable of running a state-of the-art medical facility or medical program efficiently and effectively. In fact, the opposite is true. Because private insurance companies are dedicated to maximizing profits and are accountable to no one but their shareholders (while government is accountable to the public), what has evolved in the United States is a health care system divided into the “haves” and the “have-nots”. The “haves” have good insurance and receive everything modern medicine can provide, no matter how expensive. The “have-nots,” who have poor insurance or none at all, receive very little health care despite their need for it..

By way of example, Paul Krugman cites a study which found that among Americans with colon cancer, those without insurance were 70% more likely to die over the next three years. This is no surprise. A 1993 study on access to care among adolescents, published in the American Journal of Public Health,1 found that poor adolescents had a significantly lower rate of visits to see physicians. The study found that the availability of health insurance was directly related to use of health services. Logically, individuals without insurance tend not to seek medical help because they can’t afford it. In a decent society, such disparities in access to health care cannot be permitted to continue.

It is time to stop playing politics with health care. It is time to reverse the ideology of the Bush administration which holds that private insurers are more efficient at delivering health care – according to all the evidence, they’re not. It is time to stop allowing insurance and pharmaceutical companies from maximizing their profits and lobbying our elected representatives in ways that pervert our health care system.

Certainly, in a single payer system, which I strongly advocate, individuals could choose to purchase additional medical care through private insurance, as they do in Britain. But the core of the system should be universal health insurance for everyone – healthy and unhealthy, rich and poor, old and young, veteran and civilian. Universal, government-funded health insurance will guarantee access, decreases costs, integrate care, and achieve better outcomes. Americans deserve no less.

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Krugman, Paul. New York Review of Books. Vol. 53, No. 5, 3-23-06.
Krugman, Paul. New York Review of Books. Vol. 53, No. 5, 3-23-06.
Krugman, Paul. New York Review of Books. Vol. 53, No. 5, 3-23-06.

T. Lieu, Race, Ethnicity,and Access to Ambulatory Care Among U.S. Adolescents, American Journal of Public Health, vol. 87, no. 7, pages 960-65 (1993).