USA Today by Ida Hellander and Don McCanne

Upping patients' share of premiums and medical bills won't slow skyrocketing health-care costs. But it will penalize the sick and keep millions away from life-saving care.

Americans already pay more out-of-pocket for health care than patients in any other country. Yet we have the world's highest health-care costs. We're not getting much for our money: A recent World Health Organization study ranked the USA a dismal 37th in the quality of our health system. Meanwhile, 43 million Americans are uninsured; a recession would push that number to 60 million.

The last time premiums were rising in the double digits, policymakers herded workers en masse into skimpy HMOs. A decade later, studies show that HMOs didn't save us a dime; they just diverted money from patient care to bureaucrats and investors. It's now clear that the slowdown in premium increases in the mid-1990s came from a downturn in the insurance-underwriting cycle, not from HMO bean counters.

Meanwhile, HMOs sucked billions out of Medicare, then dropped seniors once the profits dried up. Rather than admit their world-class incompetence, the policymakers who pushed HMOs now want to shift the blame, and more of the health-cost burden, to working families and sick people.

What happens when you raise co-pays and force people into skimpier plans? Sick people don't go to the doctor, and many skip essential medications. Some make it through on their own: The cough turns out to be a cold, not lung cancer; the stomachache is food poisoning, not appendicitis. But some don't. Already, emergency-room doctors report seeing more patients who wait until their illness has advanced to stages previously seen only in the Third World.

And shifting costs onto patients is totally unnecessary for cost containment. Most other wealthy nations � Sweden, Norway, Denmark, France, Germany, Canada and Australia � control costs without significant co-payments or deductibles, while allowing patients a free choice of doctors.

Their secret? National health insurance. You make a health-care budget for the country as a whole. You cut out the HMO middlemen and strictly limit health-care bureaucracy to 2%-3% of costs. (We squander 25% on paperwork.) You negotiate fees with doctors and hospitals, and bargain hard for the best prices from the giant multinational drug companies. The savings on bureaucracy and corporate profits would allow us to fully cover everyone for what we're now spending.

Upping costs for families and the sick would cause millions of casualties. National health insurance would cause just two: HMOs and obscene drug-company profits.

Ida Hellander, M.D., is executive director, and Don McCanne, M.D., director of Physicians for a National Health Program

Copyright 2001 USA TODAY