Posted on June 30, 2003

National Health Insurance Is the Obvious Prescription


I have practiced medicine in Chicago for more than 50 years, but these days, I spend much of my time advocating for health-care reform. Like Presidents Harry Truman and John Kennedy, I propose that we adopt national health insurance, administered via the government, as with Medicare and Social Security. In policy wonk circles, this sort of reform is known as “single-payer.”

Because there is broad consensus that the present system is broken and costs are unbearable, my essential argument is as follows: We already have all the necessary resources to provide care for everyone, including the 42 million people who are presently uninsured. We also have the means, right now, to assure coverage for prescription drugs, home care for the aging and disabled, and parity in mental health care. What are these resources? First, money. We will spend $1.6 trillion on health care this year, nearly $6,000 per capita, which is twice as much as any other nation. We have abundant facilities and high-tech capability—overly abundant some would say.

Second, we have the knowledge. We have a superbly trained health force of nearly 10 million people, including 600,000 physicians and more than 2 million registered nurses.

The problems in our health system arise from a national penchant to treat health care as a commodity and to blindly pursue a free-market strategy despite the obvious differences between, say, health care and DVD players. In theory, supply meets demand, and vigorous competition increases efficiency and effectiveness. In practice, more than 18,000 people die every year for lack of coverage while costs are skyrocketing and Enron-like scandals are becoming the norm in for-profit health care.

Our health resources hemorrhage into private-insurance bureaucracy (25 cents of every dollar), shocking executive salaries, and, most recently, billions in fines for civil and criminal violations. For example, HCA Inc., the world’s largest for-profit hospital chain, has paid $1.7 billion to various government agencies for defrauding Medicare and Medicaid. HCA, incidentally, was founded by the father and brother of Senate Majority Leader Bill Frist, whose HCA holdings exceed $26 million. Is there a conflict here?

Other nations’ success

Because national health insurance works well for the 20-odd wealthy, industrialized nations of the world—Taiwan’s program adopted in the mid-1990s is the most recent success—it is useful to examine what the obstacles are to single-payer reform in the U.S.

Our American system is employment-based, and business and labor unions won’t forgo this arrangement. Well, guess what? Last fall a remarkable statement was released by the Big Three automakers in Canada. It said, in part, “The [Canadian] public health-care system significantly reduces total labor costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S.-based automakers; these health insurance savings can amount to several dollars per hour of labor worked. Publicly-funded health care thus accounts for a significant portion of Canada’s overall labor cost advantage in auto assembly, versus the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada.”

On this side of the border, William Clay Ford Jr., the chairman of Ford Motor Co., said that the rising cost of health benefits is the “biggest issue on our plate that we can’t solve. Health care is out of control. It’s a system that’s broke.”

Further, noting that the U.S. is the only major industrialized country with an employer-based health-care system, Ford said the ever-rising costs of health care put U.S. companies at a competitive disadvantage.

As for labor, the U.S. president of the United Auto Workers, Ron Gettelfinger, asserted in April, “We need a universal, comprehensive, single-payer health-care program to cover every man, woman and child in the United States. You can’t fix the health-care crisis in American at any one bargaining table with any one employer or within any one industry.”

At long last it seems that business and labor are getting the message. Because rising costs, the source of their enlightenment, are only going to worsen, the enormous strength of business and labor may well be moving toward applying political pressure for reform.

Facts dispute certain notions

Despite the American people’s disdain for “government medicine,” the nation’s experience with “government medicine” has largely been favorable: The National Institutes of Health account for our success in biomedical research. Our Centers for Disease Control safeguard the public’s health. Medicare is a lifeline for 33 million seniors. Our public hospitals, such as Cook County, serve millions of the most vulnerable. The American people reject taxes for health insurance schemes. The ideologues have been successful in making new tax levies politically taboo, even when they would eliminate spending for insurance premiums and reduce total health-care spending.

Americans are already paying more per capita in taxes and tax credits for health care than any other nation. The public should recognize that, in addition to other problems, our health system is a colossal rip-off. We pay for national health insurance, but because the resources are squandered, we don’t get it.

Common belief is that national health insurance is not feasible in America. At bottom, this turns out to mean that its powerful opponents in the insurance, drug and medical industry cannot be overcome.

Well, maybe.

But history records the ability of our people to overcome seemingly insurmountable realities, such as human slavery and denial of legal status to American women.

National health insurance deserves bipartisan support: There are just as many uninsured Republicans as Democrats. It would, in the end, make us a healthier and more unified people.