Monday, September 05, 2005

A National Health Insurance Program for the United States

I am going to try to write this objectively, i.e., without using the <rant> tag.  

Just as 2002-2004 was the "post-9/11 world", we now live in the post-Katrina world.  Everything is different now.  The national political debate will shift.  It will be difficult for citizens to keep in mind the fact that we can't and shouldn't make national policy on the basis of a single topic.

Prior to the last Presidential election, potential voters listed health care, education, and the environment as major concerns.  But in the post-9/11 world, none of that mattered.  As a result, those issues got drowned out; they played no discernible role in the outcome of the election.

This was terribly ironic, since national security actually depends upon those issues.  National security, thought of broadly, is the security of our people and our land.  What difference does it make if we prevent some terrorist from launching a chemical attack, yet we allow our own corporations to poison us with lead and mercury?  How are we going to defend ourselves, if we don't education our children;  All of our children?  And what good does it do to spend hundreds of billions of dollars fighting terrorism, when the lack of universal health coverage leads to 18,000 excess deaths per year?

Most readers of Grand Rounds are educated people, people in a position to make a difference.  One way we can make a difference is to insist that our leaders give us the national debate that we want, that we need, to keep our Nation great.  We cannot afford to let them -- Democrat, Republican, Green, whatever -- shape the national debate.  
We must shape the debate for them, not the other way around.  

I am aware of the fact that many physicians oppose the concept of universal health coverage.  I also am aware that many support it.  My casual observations indicate that it is mostly the younger ones who support it; but of course, they are not the ones in positions of influence.  Yet.  

It would be difficult to outline the rationale for universal health coverage in a brief essay.  Fortunately, anyone reading this has access to the Internet, and there already are several excellent sources available.  Probably the best summary can be found in the online, open-access medical journal, PLoS Medicine.  

If you are not familiar with it, PLoS-M has an excellent Policy Forum section.  One of the earliest articles in that section was this one:
A National Health Insurance Program for the United States
The country must abandon its fragmented system

Don R. McCanne

The total projected spending on health care in the United States for 2004 is $1.79 trillion—15.5% of its gross domestic product [1]. That amounts to $6,167 per person, almost twice what most nations with comprehensive systems spend on care. Most policy analysts agree that this level of spending should be more than enough to provide all Americans with high quality, comprehensive health care. Yet the United States falls far short of these goals. What are the flaws in the United States health system that prevent Americans from receiving value from this huge health care investment? And what are the options for improvement? [...]
Dr. McCanne points out a few essential facts, such as this:
In 2000, the World Health Organization rated the United States first in its health expenditures per capita, but 37th in its overall health system performance, below most industrialized nations [9]. The United States is clearly not receiving adequate value for its health care investment.
In other words, we spend more but get less.  One reason for that, is the inefficiency that is inherent in the current, highly fragmented, highly redundant health care financing system.  Private insurance eats up 15 to 25% of our health care dollars.  (Although some of that is offset by savings introduced by rule-based care, sometimes known as "managed" care.)  In contrast, Medicare has an overhead of just 3%.  

Many objections have been raised, regarding the prospect of universal health care.  Most of these are addressed in a short article on the Physicians for a National Health Plan (PNHP) site: Single-Payer Myths; Single-Payer Facts.  

It's not that politicians have ignored the issue.  The problem is that the citizens have allowed them to demote the issue to the point that it gets lost in all the fuss about the more obvious aspects of national security.  Also, persons with their own agendas have spread misinformation about the subject.  Worse, citizens have not taken the time to inform themselves about the details of the subject.  Instead, they draw conclusions based upon broad, but misguided, generalizations and assumptions.  

John Kerry had an idea, to have the federal government pay for catastrophic coverage.  Brad DeLong argued for this on his blog, here.  Dennis Kucinich also had a plan, one which I think was even better:  
The type of system I am proposing -- privately delivered health care, publicly financed -- has worked well in other countries, none of which spend as much per capita on health care as the United States. The cost-effectiveness of a single-payer system has been affirmed in many studies, including those conducted by the Congressional Budget Office and the General Accounting Office. The GAO has said: "If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs (10% to private insurers) would be more than enough to offset the expense of universal coverage."
As it happens, the crux of his plan is the same as that proposed by PNHP.

I am not foolish enough to think that that anyone is going to have a change of heart, or mind, as a result of this post.  However, I am optimistic enough to think that some people will take the take the time to become more informed about the subject.  Perhaps then, they will press for much-needed change, based upon their own informed positions.

Categories: science, medicine
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(Note: The Rest of the Story/Corpus Callosum has moved. Visit the new site here.)
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Well, I'm still concerned. If there was a way to do a single payer system that let me see MY doctor when I chose, get the tests MY doctor wanted without limitation, let my doctor prescribed the drugs he wanted (no in-or-out of formulary bull) and gave ME the ability manage my own care, I'd say sure. I guess what I'm saying is let the government pay but keep their nose out of my business. Is that even possible?
I don't want any restrictions on where, who, or how I choose my healthcare or how often. I have that freedom now under my private insurance.
Under the Australian system you have two main choices, take the free healthcare with limitations on which doctors you can see and waiting lists (but hardly any limits on the actual tests etc), pay (a lot less than Americans do) for private health insurance and get private rooms, choice of doctor, no waitinglist etc, either way you get subsidised prescriptions, and free emergency treatment. You could also choose to have the government pay its scheduled fee and make up the rest out of pocket if you want a private doctor etc but don't want private health insurance.
I just love how some people go on about choice in docs or treatments or drugs as if health care is about what color, size, and shape you want your couch to be. While there is a lot of art in medicine, its underpinning is still science and the inter-related connections, both internally and externally, that determine health or illness.

Antibiotics are not effective against colds and flus, no matter how much "choice" you have.

And for Kim, I had much better care, better docs, and better medicine being practiced with military and Public Health Service Hospital docs and staff than I ever had in the private sector. They practice medicine not cost cutting to pad CEO pay.
It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.
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