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ABC News' Medical Editor Dr. Tim Johnson says the U.S. health-care system is in Critical Condition

ABC News' Medical Editor Dr. Tim Johnson says the U.S. health-care system is in Critical Condition.(ABCNEWS)

Peter Jennings Interviews ABCNEWS’Medical Editor on the Health-Care Crisis

Oct. 21 — Did you know that the United States spends more on health care, per capita, than any other country in the world?

Even so, 43 million Americans have no health-care coverage — including one in 10 children. Americans spend $1.6 trillion on health care and much of the system is clearly troubled.

Insurance premiums are going up for the third year in a row. Americans already pay twice as much for prescription drugs as anyone else. The ramifications of all this are huge in the world's richest nation.

Every other country with a single-payer system, and all of the rich ones do, manage to cover everyone, have universal care, get very good results and do it at a far lower overhead than in the United States have.

This week, every news program on ABCNEWS is taking a closer look at the American health-care system. Peter Jennings interviewed ABCNEWS' medical editor, Dr. Timothy Johnson for Critical Condition.

Peter Jennings: Tim, you helped us decide on the name of the series, Critical Condition. What is it essentially that is so critical?

Dr. Timothy Johnson: Costs are rising, we're getting less for our money, we spend twice as much per person on health care in this country than any other industrialized country but we have 43 million uninsured. So we spend a lot of money but we don't take care of a large section of our population. I think we're at a critical juncture as to how we should proceed.

Jennings: So you think it's a critical juncture as well as a critical condition.

Johnson: Yes, I think that's a fair statement. Certainly for some people it's a critical condition. The uninsured in our country, we know that they have a 15 to 18 percent mortality rate increase compared to those that are insured. We know that 18,000 of the uninsured die each year in this country for lack of insurance. For them, it's critical condition. But for the rest of us it's a critical juncture: What's going to happen to our health insurance?
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Jennings: Why are so many people in the ABCNEWS poll apparently happy with their health care? [The poll found 64 percent of people with health insurance said they are satisfied with their health care, but 59 percent are worried about being able to afford it in the future.]

Johnson: That's always been an interesting question. They feel good about their own doctor, their own hospital. But when they start to think about it as a system, and what may happen to their health insurance and their employment, they get worried.

Jennings: Do you see a change in this for a year ago or two years ago?

Johnson: Absolutely. They numbers of concerned are going up. Three years ago, 44 percent were concerned about the overall care in this country, now 54 percent … that's a 10 percent increase in just three years.

Jennings: The conventional wisdom is Americans like to think that we have the best health-care system in the world.

Johnson: And we do, certainly for people that are very rich or who have very good health insurance and who have very good connections into the health-care system. But for too large a number, 43 million, and many who are underinsured, it is not the very best system in the world.

Jennings: So what was notable in that regard in this poll this time?

Johnson: What was notable is that 62 percent of our population said that they would favor a system of universal health insurance financed by the government, paid for by the tax payers, as opposed to the system we now have, the employer based system where many people are uninsured. I was stunned by that figure.

Jennings: I think conventional wisdom has it that in America, land of the free, that the marketplace is where the price is best established.
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Johnson: That's true for commodities like a car, where you can go in and make choices and you can even walk out of the showroom if you want. You can't do that when you're sick. You can't do that with health care. So, for health care, you're talking about a service and here I think the private sector has some real shortcomings. They have to spend a lot of overhead on sales and marketing and choosing the patients they're going to serve. They shuffle a lot of paperwork. Their administrative paperwork is 15 percent versus the accepted figure of 3 percent for Medicare which is a single payer system where the government handles the money. The delivery system is free. You can pick whatever doctor or hospital you want.

Jennings: Why couldn't you regard health care as a commodity the way you regard cars?

Johnson: Because in order for it to be a commodity you have to have a consumer who's informed and can make choices. The consumer can go in and say I want this color, they have the information to make choices; they can walk away from the offered product. Think about getting a colonoscopy, a very common procedure today. Where can you find the Web site that tells you who is the best at it, where it might be the cheapest, who has the most training? The consumer doesn't have the information to make the choices necessary for a commodity in the free marketplace.

Jennings: Some will say that Americans need to take more personal responsibility for their health care and be better informed.

Johnson: I would not disagree with that. And I think that if we could get better information that will certainly be part of our responsibilities as consumers but right now, that information is very hard to come by. The marketplace doesn't really exist in terms of consumer information for health care.
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Jennings: Now, I think that the conventional wisdom is still the single-payer system, as you and others have described it, is socialized medicine and that isn't for the U.S.

Johnson: Socialized medicine means that the government both finances health care and owns and operates the doctors and the hospitals.

Jennings: Like Britain?

Johnson: Like Britain. In Canada, it's a split system. The government indeed does collect the money and disperse it. They run the financial part of health care. But the delivery system is free. People can choose whatever doctor or hospital they want to go to. So, we have a system like that in this country. It's called Medicare. That's exactly what happens with Medicare. So, to call the Canadian system socialized is to call Medicare socialized. I think it's a pejorative word and inaccurate.

Jennings: When I walk past people who know that we're doing this series this week and I mention the single-payer system, they just say, "Never in America."

Johnson: I've talked to elderly people who say they love Medicare but they don't want the government involved. They forget that the government has a role to play in setting standards, maybe in handling the money with lower administrative costs. It would be a tragedy for the government to try to run the health-care system in terms of delivery.

Jennings: On top of which, many Americans hold it to be conventional wisdom that private is better than public. Period.

Johnson: In fact the government does a few things well. And I'll hold up one example in the health-care system: The NIH, the National Institutes of Health, is the shining gem of medical research in this entire world. It's owned and run by the government. They can do some things well, especially when it comes to health care. Not everything, but some things.

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Johnson: And the Republicans in general are very much opposed to that. But at the same time, they realize that Medicare is an example of something that works in part. It needs to be reformed, we need to have a drug benefit, we need to improve the services. They're behind the times. We need to probably spend more money, believe it or not. At least on some of the administration. But, the same Republicans who don't want a single-payer system would be loathe to say to our senior citizens, "We're going to take away from you the one single-payer system we do have" — it's called Medicare.

Jennings: We're coming into an election year. It's clearly a hot political subject. Do you think there is the political will in the country to compromise and provide a system with which all people of all political ideologies would agree?

Johnson: I would like to think so. I'm probably pessimistic about it, but with the latest poll results from our own poll, I'm more optimistic because all of a sudden we have a majority of people who are thinking in that direction. And that is what it's going to take —a political majority to put pressure on congress. I think the heart of the American people want to do something right, in terms of the uninsured, and I think that the politicians will be dragged along.

Jennings: Conventional wisdom holds that, I think, that with the uninsured, they still have access to American medical care, they have it in the emergency room.
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Johnson: I would call that a real misunderstanding. It is true. We do not let people die in the streets if they get sick enough, they will get to the emergency room, but all too often by that time, they're so much sicker that their outcomes are less assured. It's going to cost a lot more money to take care of them. We have access through the emergency room, but if we could have it earlier through insurance coverage we could provide it at less cost, with better outcomes and with more dignity.

Jennings: If the uninsured are crowding the emergency rooms for basic care, is that adding to the cost of health care for the rest of us?

Johnson: It is. Somebody has to pay those bills, obviously. And it falls on local and state and to some degree, federal governments. But we pay a much higher price, I think, in the moral issue involved and the medical outcomes involved.