U.S. should focus on finding cure to health-care debacle
WILLIAM CONNOLLY, Columnist
The Evansville Courier & Press
Sunday, January 21, 2007
According to a recent Parade Magazine article by David Wallechinsky, patriotic sentiments notwithstanding, while the United States is still No. 1 in some respects - Nobel prize winners, billionaires and armed forces stationed in other countries - we lag far behind in other categories that more accurately assess social well-being. We lag behind other countries when it comes to health care. Thirty-three countries, including Cuba, have lower infant death rates; 43 have more physicians per capita, including France, Switzerland, Mongolia and Lebanon; and 49 have more hospital beds per capita, including England, Italy and Ireland.
We rank 29th in maternal death rate, 30th in life expectancy for women and 28th for men. All this despite our spending more per capita on health care ($5,700) and as a percentage of gross domestic product (more than 15 percent), higher than any other country.
So why don’t we do better? Perhaps this is a matter of lifestyle. We consume too many calories - we’re No. 1 in obesity. Despite being obsessed with sports, most of the time we are only spectators, not participants. We are inactive at all ages. We have the 15th highest murder rate.
The data also reflect an ailing health-care system, afflicted with confusing, conflicting and inefficient ways of financing care. Most comes from private insurance tied to employment. That system leaves more than 45 million Americans uninsured.
Because the system is composed primarily of the working poor, they end up served by inadequately funded public assistance. They postpone treatment and rely on more expensive emergency care, funded indirectly by the insured. This indirectly increases their costs. As the U.S auto industries have learned, the costs further harm their global competitiveness.
But there is some good news on the horizon. While Washington has provided little leadership, states are beginning to explore alternatives. California Gov. Arnold Schwarzenegger recently promoted an ambitious plan to provide coverage for all Californians. His goal is commendable because his plan promises universal coverage, requiring all to buy health insurance.
Those who cannot afford it will be provided financial assistance. Insurance companies are required to sell insurance to everyone at the same price. It would enable people to obtain preventive care rather than wait for more expensive emergency care. Since insurers have to provide coverage to everyone, they would not waste resources trying to deny coverage. This would allow for more spending on actual care. Furthermore, insurers would have to spend at least 85 percent of premiums on health care, which is quite the improvement.
The program will, however, result in substantial government intrusion to ensure that people buy insurance. It will also determine who will receive assistance and police insurers, guaranteeing their compliance. All of this seems necessary to keep insurance companies in the game. This may make Schwarzenegger’s proposal more politically appealing to insurance companies that plan to do well in this program. However, this complex interplay of private insurers and government killed the Clinton proposals in the early 1990s.
Why not eliminate the middleman and opt for a single-payer system similar to Medicare, contributed to by everyone, including employers? It would be simpler - and cheaper - for employers and health-care providers.
This is a worthwhile debate. While I believe a single-payer system would be better, Schwarzenegger deserves credit for bringing the issue to the table.
© 2006 The Evansville Courier Co.