Time for strong medicine
Time for strong medicine
8/19/2003
AMERICANS SPEND more than anyone else in the world on health care, but with 41 million people uninsured, they are paying for a system that is both unjust and inefficient. It is refreshing that at a time of retrenchment, the prestigious Journal of the American Medical Association has published an article urging that the United States adopt a single-payer system that would cover every American.
This approach represents a major contrast with the incrementalism that has resulted in a few improvements in coverage since the Clinton health plan died in Congress nine years ago. Now states are cutting back their Medicaid programs, employers are shifting more health costs directly to workers, and the Bush administration is showing little interest in expanding coverage.
The article by the Physicians’ Working Group for Single-Payer National Health Insurance asks, in effect, “Why keep paying for a dysfunctional system that costs $1.4 trillion a year?” The physicians propose replacing it with an expanded Medicare program for every American but adding a drug benefit, which Medicare lacks, and other improvements.
A single-payer plan would affect the interests of powerful economic lobbies. Private health insurers would not be needed if the government paid for all care directly to providers. Drug companies would be less able to charge exorbitant prices if they had to deal with one powerful customer, the US government. Income for some physicians might go down as more money was devoted to primary care and less to some procedures that are not as demonstrably beneficial.
The American Medical Association — which treats JAMA as an autonomous publication — promptly disassociated itself from the article. The AMA said it feared the prospect of rationing, as occurs in some countries with single-payer coverage. But other nations spend far less per capita on health care than the United States. Enough money sloshes around the US system to provide excellent care for everybody if it is spent wisely.
Costs are hidden and fragmented in the US system to such an extent that individuals rarely know what their health insurance costs. The physicians’ plan would replace this with a single revenue stream generated by taxes. That would cause the antitax lobby to howl, but it is better to confront the costs directly and debate them in a democratic process rather than having decisions diffused among government, employers, drug companies, and private insurers.
The physicians’ plan will have to contend with distrust of big government expressed by many Americans. Yet a majority believe that health care should not be a market commodity. The popularity of Medicare suggests that at least here, government is doing a creditable job.
“Access to comprehensive health care is a human right,” says the physicians’ group. A hodgepodge health care system is failing too many Americans. It’s time for a new approach with a goal of universal coverage. Single payer is a prominent option.
© Copyright 2003 Globe Newspaper Company.