Nobody likes taking their medicine, and I'm afraid America will simply refuse to get better.
Devising health care for us all
System’s too profitable, for some, to change
The Health Care Debate is starting to sound more and more like the opening of a Twilight Zone episode. You know it’s going to be scary even before it starts. Then Rod Serling’s voice says, “For your consideration: 47 million Americans live without health insurance.”
Between 1975 and 2005, health expenditures grew 2.79 percent per year faster than the rest of the economy. Premiums for family health care coverage have increased 78 percent since 2001. Despite this increase in costs, service is worse: Americans now lag behind the rest of the developing world in both longevity and even infant mortality.
Something has to change.
My colleagues on the Opinion page have weighed in on health care, all rushing to endorse some version of a free-market approach. John Torinus who, alone among these commentators, has a sufficiently sophisticated understanding of economics to make sense of the tangle of stakeholders and profit centers (he’s clearly read Stiglitz as well as Friedman) provides the best freemarket option by asking for transparency in cost structures. If consumers and businesses had a clear understanding of the actual costs, customers could make informed choices and, thus, the market would respond by providing the lowest price.
It’s a good idea, but it’s only a temporary solution. The real problem in health care is the system itself: in other words, scrubbing decks on the Titanic won’t help much with that inbound iceberg.
The free-market created a health insurance system incentivized to make money when it doesn’t have to pay for your health care. As Physicians for a National Health Program point out: “This creates the paradox of a health care system based on avoiding the sick.”
Instead of treating health care like another commodity, like pork bellies or orange juice – a thing to be traded for profit – we need to start thinking of health care as social infrastructure. Health care, in other words, should be no different from interstate highways or dams on the Mississippi river and the most cost-effective approach is a single-payer health care system.
Those opposed are likely to lose a lot of money, and they have ginned up a powerful disinformation campaign. Here’s a quick look at the usual complaints:
- A national single-payer system is socialist.
If true, then we’re already a socialist country. Over half of all current health spending in the United States is financed by taxpayers at the federal, state, and local level.
- Government is notoriously inefficient.
Surprisingly, not true. Thirty-one percent of current health spending is spent on administration. Medicare, by contrast, operates with just 3 percent overhead. Canadian provincial health care averages even lower at around 1 percent – and Canadian life expectancy is two years longer than ours. Recent estimates in the International Journal of Health Services indicate that the United States spends between 50 and 100 percent more on administration for health care than countries with single-payer systems.
Moreover, both the Congressional Budget Office and the General Accounting Office have reports going back to 1991 indicating that moving to a single-payer system would save enough from waste alone to pay for those not insured.
- We’ll have to ration care.
Care is already rationed. Most of us with insurance don’t get to pick our own doctor and we still have long waits for necessary tests and services. But rationing can be even more insidious. Insurers ration health care by making it too expensive for many people to afford and then shift those costs to the taxpayer – who pays emergency care rates (the most expensive kind) for these folks when they seek treatment at the last moment. Frankly, insurance with a $3,000 annual deductible is no insurance at all. Here’s what rationing really looks like: 25 percent of Americans didn’t go to the doctor last year when they needed to because they didn’t have the money. In Canada, the rate was only 4 to 5 percent, in Britain 2 to 3 percent.
Single-payer is our best, most economically responsible and prudent option, but – and here’s the Twilight Zone ending – we probably aren’t going to get it. The fact that both the pharmaceutical lobby and AARP support the plan currently under construction in Congress tells me it’s already been compromised. We’re destined for more of the same.
I can only hope that Mr. Obama understands this and that the so-called “public option” still on the table, will be a first step toward a more efficient, and maybe even just, health care system for all Americans.