By FRITZ LOEWENSTEIN. M.D.
January 26, 2006
Assuming health care, like food and shelter, is a necessity of life, the nation's present health care system, if it can be called a system, has failed miserably.
It is inefficient and far too costly. More than 45 million people are without health insurance and receive haphazard medical care if they receive any at all in this wealthiest of countries. Those on Medicaid also receive inferior care and many doctors and almost all dentists deny care to Medicaid recipients.
Many hospitals and health maintenance organizations (HMOs) are profit-making institutions. They operate under constant pressure to limit services in order to reward stockholders. In other respects too, they incorporate some of the worst features of big business — overpaid executives, some of whom have been indicted for fraud; questionable accounting practices; takeovers of plans with sudden changes in costs and benefits; and termination of programs due to bankruptcy.
Approximately 25 percent of every health care dollar spent in the United States goes to administrative costs, which add up to $294 billion annually. Canadian Provincial Plans spent proportionally less than one-third that amount. In the Medicare program, only 6 percent of total expenditures go to administrative costs.
HMOs, hospitals and drug companies spend huge amounts of money on advertising and promotion, with all the expenses ultimately borne by the consumer. Health insurance premiums, already high, have risen an additional 27 percent for individuals and 16 percent for families during the past year. Small-business owners are no longer buying health insurance for their employees, and increasing numbers of workers cannot afford to pay the premiums.
Many companies now prefer to hire part-time workers in order to avoid paying for health insurance. As a result, more of the working poor are left without coverage and middle-class families are increasingly anxious about possible financial ruin that may result from a serious illness.
Clearly, we need to reform the system. A publicly administered program of universal health insurance, similar to Medicare, would eliminate most of the inequities and inefficiencies. A California study showed that such a plan would cover all that state's residents, including the 6 million uninsured, and save over $7 billion annually in health spending.
Most polls have shown the public favors such a course. Funding would need to come from payroll and income taxes, but premiums and deductibles would be small and the overall cost to business and individuals would be much lower than they are now.
Achieving this will not be easy. Presidents Truman and Clinton tried and failed. The health insurance industry has powerful lobbies in Washington and in state capitals who influence lawmakers to oppose change. Adding insult to injury, the cost of that lobbying, harmful to the consumer, is also borne by the consumer.
However, there are encouraging signs. The Journal of the American Medical Association has taken a strong stance in support of the development of government-supervised universal health insurance. The Institute of Medicine of the National Academy of Sciences also has called for a universal health care plan.
To those who disapprove of government involvement in health care, it should be pointed out that Medicare is both fair and practical, and extension of the program to cover the entire population would be entirely reasonable. The savings in administrative costs alone would amount to many billions of dollars annually.
I know of no patients who ever failed to enroll in Medicare, whereas many patients have complained of lack of coverage, difficulty in obtaining benefits, and high premiums in the private plans.
The recently enacted modification of Medicare by the Bush administration and narrowly passed by Congress takes the program in exactly the wrong direction by introducing private plans. Furthermore, the drug provisions give high rewards to the pharmaceutical industry at the expense of the consumer.
In short, we must adopt a nationwide, single-payer system supervised by the government. But for that to happen, intense pressure needs to be applied to legislators by an informed public.
Loewenstein is a retired physician in Binghamton, NY.
© 2005 Binghamton Press & Sun-Bulletin – Binghamton, NY