by Dee Newman
Many Americans still cling to the false belief that “the United States has the best health care system in the world.”
However, a poll that was released in March of last year by the Harvard School of Public Health found that although Americans are divided along political lines, overall, only 45% of Americans (68% of Republicans, 40% of Independents, and 32% of Democrats) now believe that the United States health care system is the best in the world.
The sad and disturbing truth is the U.S. health care system is both outrageously expensive and inadequate. The United States must bring its health care costs under control and make it possible for every person in the country to have access to affordable health care.
Despite spending more on health care per person, per year than any other nation in the world, the United States lags far behind other industrialized nations on many major health care statistics – such as life expectancy, infant mortality, and immunization rates.
Moreover, other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves nearly 50 million Americans completely uninsured and millions more inadequately covered.
Most uninsured Americans are working-class people whose employers do not provide health insurance and who earn too much money to qualify for one of the local or state insurance programs for the poor, but do not earn enough to cover the cost of enrollment in a health insurance plan designed for individuals.
Today, most employer-provided health care plans are offered through managed care organizations. Managed care organizations include both health maintenance organizations (HMOs) and preferred provider organizations (PPOs). In an HMO, health care is covered only for services delivered by providers in the network with whom the health plan has contracted. A PPO covers health care services delivered by either in-network or out-of-network providers.
The quality of health care in the U.S. has deteriorated under managed care. Access problems have increased. The number of uninsured has dramatically grown year after year, especially among children.
The federal government in 1997 finally, after years of ignoring the problem, created the State Children's Health Program (SCHIP), a joint federal-state program to insure children in families that earn too much to qualify for Medicaid but not enough to afford health insurance. The program, however, for years has faced funding shortfalls in many states.
Fortunately, on February the 4th President Obama signed into law legislation to expand the health-care program for millions of uninsured children. The Democratic effort to expand the program had been repeatedly blocked by Congressional Republicans and former President George W. Bush.
Those in favor of universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all through higher health insurance premiums and/or taxes and that extending coverage to all would lower costs and improve quality of care.
Although the U.S. may have the most expensive and the most advanced medical technology in the world, it has not translated into better health care for its citizens.
In comparative study after study, report after report, the statistics show that the United States ranks at or near the bottom of all the major industrialized nations in the delivery of health care to its citizens.
For example: among the 191 member nations included in the World Health Organization study in 2000, the U.S. health care system only ranked first in cost and expenditure, but a dismal 37th in overall performance and 72nd in overall levels of health.
The CIA World Factbook ranks the United States 41st in the world for lowest infant mortality rate and only 45th for highest total life expectancy.
Overall, the United States ranks a depressing and deplorable 67th (right behind Botswana) in immunizations for its children.
The latest report of the highly regarded Common Wealth Fund ranked the U.S. health care system dead last or next to last on most measures of performance, including quality of care and access.
According to the Institute of Medicine of the National Academy of Sciences, the United States is the only wealthy, industrialized nation that does not have a universal health care system.
Though most American now recognize that the U.S. health care system is badly in need of repair and must be reformed, a government-authorized system of universal health care in the U.S. remains intensely controversial. Americans are extremely divided along party lines in both their views of the U.S. health care system and what must be done to improve it.
Opponents of universal health care fear and believe that the system will be too expensive and deprive them of needed services. They believe this in spite of the fact that the United States now spends at least 40 percent more per capita on health care than any other industrialized nation that provides universal health care to its citizens. They believe it even though the U.S. system still leaves 48 million Americans without health care coverage and millions more inadequately insured.
Furthermore, contrary to what opponents fear and believe, single payer, universal health care is not socialized medicine. It is a health care payment system. It is not a health care delivery system and is no more socialized medicine than the public funding of the defense department is socialized defense.
Unlike the current managed care system here in the U.S. which mandates pre-approval of the insurer for services and which takes health care decisions away from the doctor and patient, a single payer, universal health care system would not.
Financing a single-payer system would be done by eliminating private insurers and recapturing their administrative waste.
A small increase in taxes would replace premiums and out-of-pocket payments currently paid by individuals and business.
Costs would be controlled through negotiated fees, mass purchasing, and universal budgeting.
Health care spending in the U.S. totals more than $2 trillion, or 16 percent of GDP. And, it is increasing every year. It is projected by the year 2017 health care spending will reach 19.5 percent of GDP.
The reason we spend more and get less for our buck than other nations is because we have a hodgepodge of government and private for-profit payers. We waste billions of health dollars on things that have nothing to do with care: underwriting, billing, sales and marketing, as well as, huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with both bureaucracies. The overhead is excessive.
Single-payer financing is the only way to recapture this wasted money. The potential savings is more than $350 billion per year and certainly is more than enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
A government single-payer, universal health care system that is open to everyone and does not waste money on marketing, high paid executives, and dividends for shareholders, would be far more efficient than the mix-bag of government and private for-profit plans we now have in this country.
A universal government plan would also have the power to force the pharmaceutical industry and the medical supply industry to take sharp discounts compared with the prices they currently charge patients today.
The controversy of providing universal health care for United States citizens is not new. Universal health care was first introduced to the public in 1912 by Teddy Roosevelt when he made it apart of his Bull Moose Party platform and campaign.
In the 1930s Franklin Roosevelt had to eliminate his universal health care program from his New Deal agenda in order to get Social Security passed.
President Truman, too, was unsuccessful in his attempt to follow the lead of Great Britain after World War II when Parliament passed the United Kingdom’s National Health Service.
As we all know, the Clinton Administration also failed to pass universal health care coverage in the 1990s.
Though there are, at last, good reasons to believe that important progress can be made in reaching universal health care coverage, no one should ever underestimate the power of the for-profit health care industry and lobby.
A testament to the power and influence of this industry is the Medicare prescription drug benefit. Instead of simply increasing the subsidy for the program and having it cover prescription drugs, the insurance and pharmaceutical industries persuaded the Republican controlled Congress to created a stand-alone “donut-whole” prescription drug plan, prohibiting Medicare from offering its own plan or from bargaining directly with the pharmaceutical industry, allowing the industry to rake in tremendous profits.
If a single payer, universal health care system was ever put into affect, the insurance, pharmaceutical, and medical supply coalition would stand to lose big time. This powerful coalition will do whatever it takes to protect their profits. They know that as my daddy use to sarcastically say, “a pound of cure is far more profitable than an ounce of prevention.”
Unfortunately, to date these large corporations and industries have been able to “buy” politicians through our campaign finance system and control the media to convince people that the United States’ for-profit health care system is viable, democratic, and efficient.
More and more, though, a majority of physicians (psychiatrists, emergency medicine specialists, pediatricians, internists, family physicians, and general surgeons) are beginning to feel that our private, for-profit and fragmented insurance system is obstructing good patient care and are now supporting a national health care system.
In conclusion, whether the U.S. ever implements a universal health care system, we can no longer afford to live in a country with so many children living in poverty.
It is disgraceful that the United States of America, the riches country in the world, has the highest level of poverty among all wealthy nations. One of the primary reasons why Americans are less healthy than Europeans is because Europeans have worked hard to reduce the rate of poverty in their countries, especially childhood poverty.
The connection between poverty and the quality of a person’s life and health has long been established. One of the major reasons the poor are less healthy is the fact that the poor work and live in more polluted, hazardous, and stressful environments.
The impact of living in a toxic and hazardous physical environment is far more detrimental than limited access, restricted services, or inadequate medical care. A huge body of evidence has consistently shown that those who live in poverty have higher rates of mortality, morbidity, and disability.
These environmental factors are especially difficult on infants. If the United States is to improve its health statistics, it must not only pass universal health care, it must reduce poverty, especially among our young.