© The Medical-Legal News 2007
By Ralph Deitemeyer, RPh
As an ardent supporter of free enterprise and keeping government small, I and many others have equated universal healthcare coverage (UHC) with “socialized medicine.” The runaway costs, and to some extent the quality, of healthcare in the good ol’ U.S.A. have made me pause, and visit the issue with a fresh perspective.
From a personal standpoint, increased costs have me searching for answers to controlling our expenses. If I am having problems I can only imagine what people with lower incomes are experiencing.
The picture of healthcare in America is not an attractive one. We spend more money than anyone else in the world and yet have less to show for it than most developed countries. We don’t live as long. We don’t adequately cover half the population. We encourage hospitals and doctors to perform unnecessary medical procedures on people who do not need them while denying them to people who do. We force senior citizens with modest incomes to board buses to Canada to buy drugs they can’t afford in America. We clog emergency rooms with patients who can’t get in to see doctors or can’t afford co-pays. There is fraud and overbilling. Mistakes and acquired infections are greater in our hospitals and we kill more people with prescription drugs than street drugs like heroin and cocaine. We have an endless assortment of health plans to choose from, but most people have few choices. We have charity events to help pay the medical bills of friends and family when catastrophic illness occurs. Americans believe they have the best healthcare system in the world, but in truth it is second-tier and destined to get worse and more expensive.
The president and Congress must realize that when such diverse groups as unions, large corporations and consumer groups such as AARP are joining together to form a consensus solution to the problems, then they must respond. The message is clear — you must enact a bipartisan fix to this problem or we will embarrass you and nail you at the voting booths.
Recently, due to inactivity at the federal level, several states have begun their own reforms. They mirror negotiations between doctors, insurers, labor groups, drug companies, hospitals and consumer groups. As reported in The Washington Post (not one of my favorite papers), the consensus includes the following:
1. Mandated universal basic coverage to be purchased by individuals or offered by employers.
2. Subsidies to families who are up to 3oo percent of the poverty level to help pay deductibles and co-pays.
3. Tax law changes to give individuals who purchase their own insurance the same benefits as those who receive it as a fringe benefit.
4. Establish a pool in every state to allow individuals and small businesses to purchase insurance at the same rate as large corporations.
5. Set a deadline for doctors and hospitals to have computerized records and provide low interest loans to accomplish this.
For this to work all groups must make concessions.
Doctors would have to have fees tied to protocols established by various medical specialties. Hospitals would have to agree to spend 85 percent of revenues on direct care, allowing 15 percent for profit and administrative expenses. Insurers would be obligated to sell to everyone with only slight rate differences due to age and medical condition. Unions and employees would have to agree to caps on the benefits they receive tax-free.
Employers would have to “play or pay” by providing insurance or paying a subsidy to a pool. Supporters of a liberal plan would have to accept a basic plan that covers preventive care and catastrophic events, but requires patient cost sharing for routine care.
Sen. Barack Obama, in a recent speech, made a compelling argument for healthcare reform and he certainly is not alone, as other candidates echo similar platforms. Chastising those cynics who say meaningful healthcare reform is not economically feasible, he cites statistics showing family premiums increasing 85 percent in the last five years, deductibles up 50 percent, and copayments for care and prescriptions going through the roof. In calling for reform no later than the end of the next president’s term, he says not to do so would be an economic disaster.
Eleven million insured people spent more than a quarter of their salary on healthcare in 2006. Half of all bankruptcies are caused by medical bills. Nearly half of all small businesses do not offer healthcare benefits due to the cost, and others are laying off workers or closing for the same reason. Insurance premiums are more than $900 more per year just to cover the uninsured and the overuse of emergency rooms. Because of this, healthcare becomes a catch-22 system.
The uninsured cause premiums to increase, causing more people to be laid off, increasing the uninsured, leading to increased premiums and on and on.
Sen. Ron Wyden, noting the $2.2 trillion spent on healthcare each year, said we could hire a group of skilled doctors and pay them $200,000 per year to care for just seven families each, and insure everyone in America.
One-fourth of all healthcare dollars are spent on billing and paperwork. On-line administration of billing and medical records can do this for pennies on the dollar. The VA does this and has decreased the cost of pulling a medical record from $9 to next to nothing with new technology. A single transaction in the healthcare industry costs up to $25 and this does nothing to improve the quality. Such diverse political enemies as Newt Gingrich and Ted Kennedy believe we could save $600 million a year by putting our healthcare system on-line.
Forty-seven million people, more than one-sixth of Americans, are without health insurance.
President Bush’s solution to the problem is a tax deduction to buy private insurance. California governor Arnold Schwarzeneggers’s plan would force employers to provide coverage or pay into a fund. Sen. John Edwards’ plan is similar. All involve for-profit insurers, allowing them to increase their customer base, creating more profits for their shareholders and higher executive salaries and perks for the big carriers. This also will give the large insurers more power over providers and patients alike. The top six insurers had a combined profit of $10 billion last year even after spending huge amounts on marketing and administration. Wellpoint alone spent $9 billion on marketing and administration, which is nearly one-fourth of what it paid out in actual patient benefits. Normal single payer systems such as Medicare pay about 3 percent in administrative costs. There also is severe conflict of interest in the insurance industry that pits customer services against maximizing profits for executives and shareholders.
The U.S. is the only developed country lacking a form of universal healthcare. Expense is the excuse given, however data would indicate otherwise. Based on 2002 data, the U.S. system costs over $5,000 per person compared to about $2,100 per person in the other 30 developed countries. Of the roughly $5,000 per person in the U.S., nearly 42 percent comes from Medicare and Medicaid for a figure of $2,100. Do the math — shouldn’t we be able to provide the other 58 percent with care for the same or nearly the same amount? We could do this by eliminating private insurers and minimizing out of pocket expenses.
I can hear you now; you are saying the level of care and quality would suffer. Not so fast. The U.S. is currently ranked 18th in the world by the World Health Organization. The U.S. has the largest number of specialists in general care and preventive care, yet we are falling behind. How do the other countries do it?
They form a hybrid of basic universal coverage with private practice. The universal coverage is used for basic routine services, and private practice for more sophisticated treatment. People who disparage universal coverage in Canada, for example, argue that people have to wait for treatment. The reason for that is that 70 percent of doctors in Canada are in general practice and only 30 percent are specialists. For that reason many choose to come to the U.S. rather than wait, but no problem, because their insurance covers anything not immediately available there and pays better than our insurers. Provider costs are capped in Canada, but doctors may treat as many patients as they want. Doctors’ salaries average $250,000 and this compares favorably to other countries with UHC.
People argue that UHC will lead to rationing of healthcare, yet data indicate that same-day access to doctors is less in the U.S. than in most UHC countries.
Americans have the most expensive healthcare system in the world. By usual measures of health (life expectancy, infant mortality rates, immunization rates) we do worse than the developed countries with UHC. It is undeniable we spend enough to pay for UHC — and in fact it would be less expensive.
Why hasn’t UHC been adopted in the U.S.? For years the majority of Americans had private insurance through their jobs, and not having insurance was someone else’s problem. UHC promised them something they already had — and change could only be for the worse. How many people can count on that job insurance security now? Employers’ enthusiasm for paying this benefit is waning due to increased costs and global competition. Many companies are downsizing full-time employees to part-time, laying them off or not offering insurance.
Americans are unhealthier than citizens of countries with UHC. Americans do not get more healthcare than other citizens with UHC even though spending twice as much. For example, Japan has more MRI machines and CT scans than the U.S. The WHO says France has the best system — more hospitals and better access to doctors (something members of HMOs long for in this country).
The Bush plan calls for more consumer choices as the answer, with more competition among insurors. The fact is that insurance works better when there is a large pool and risk is shared. Insurers will cherry-pick healthy people to ensure profits, just as they do now. Many people complain about Medicare, but it is the most efficient provider of healthcare with a huge share of its dollars going to direct care.
The key question, of course, is whether comprehensive healthcare coverage is a right or a privilege. Countries with UHC consider it a right for basic coverage, and while many of the plans have weaknesses, they are proving quality healthcare in an efficient manner.
I believe it is time to make the decision that medical professionals must oversee our system, not for-profit insurance companies who make money by denying healthcare.
I believe to be globally competitive, American businesses can no longer shoulder the cost of healthcare. I believe we can swallow our pride and learn something from other countries. •
Ralph Deitemeyer, RPh, is a retired pharmacist. This essay was written for The Inquisitors Club, a men’s debate club.