Working to fix the health-care crisis
By W.J. Coggins
The Tuscaloosa News
Published Sunday, May 6, 2007
Public concern about the costs and conflicts in medical care and in the larger issues of health care have indeed reached crisis levels. Not a day goes by without stories in newspapers, on radio and television and in major magazines, featuring various aspects of these issues. Recently a weekday edition of The Tuscaloosa News had seven articles on various aspects of health care including Alzheimer’s disease, shaken-baby syndrome (to go from one extreme to the other), how to pay for long-term care and four others.
Total expenditures for health care in the U.S. for 2006 were an estimated $2 trillion. It is hard to conceptualize a trillion of anything, but those of you who saw the happy faces of 92,000 football fans at the A-day game in the Sunday paper can imagine each of them having $2 million to dump into a very large container. That would pay the health- care costs, public and private, for the whole country for one year. “Public” means we pay that in taxes and “private” means salary deductions and out- of-pocket payments. Typically this cost goes up about 6 percent every year. Not trivial.
The steadily rising costs of health care is a worldwide problem. In the other industrial nations where costs are rationally managed, the total burden on the economy is half as much as ours because they have a single-payer system either managed by the government or smaller governmental units. The overall quality of care in these countries, measured by life expectancy, infant mortality rates, patient satisfaction and other parameters, is better than ours.
We have fallen behind as our costs have gone up faster than theirs, principally because we have used a/smarket-based, for-profit system for health insurance, hospital ownership and for many ambulatory care services. Competition has failed to prove itself in health care, after a 50-year trial in the United States. The largest loss is not in dollars, but the steady intrusion of the for-profit motive in the actual delivery of medical care.
Doctors and their teams find themselves constrained from doing what is best for the patient by the rules of nonmedical managers. Just one of many examples is the constraint on the length of stay in the hospital. Too often patients with complicated illnesses are discharged too early unless the doctor calls a nameless, faceless person for permission to extend the stay. Likewise, return visits to the doctor are challenged, or permitted, only by time-consuming phone calls. There are many other prohibitions in providing the best care for the patient.
The eminently available answer to our failing nonsystem is a single payer plan and the successful model is Medicare. The Medicare model covering all U.S. citizens would provide hospital care, doctor visits, prescription drugs, dental care and nursing home care — with the patient’s choice of hospitals and physicians. The government would pay an intermediary, like Blue Cross Blue Shield or some other specially organized entity. The intermediary would pay physicians, hospitals and other providers. For-profit health insurance companies and for-profit hospitals would be eliminated. The cost to the taxpaying public would be a 5.8 percent tax on employers (far less than the present cost for employee benefit plans) and a 2.9 percent tax on employees.
The benefits will be immense. Our 47 million uninsured citizens will be covered. Manufacturers and other businesses will be relieved of a huge burden, making them more competitive with offshore industries.
Health care in the U.S. will be a kinder, gentler enterprise and the practice of medicine and health-care delivery in general will be more efficient and gratifying.
Those readers who are interested in helping with this problem should contact Health Care for Everyone—Alabama, 3105 Warrington Road, Birmingham, AL 35223.
W.J. Coggins, M.D, Tuscaloosa