U.S. must look for a health care system to cover everyone
By Robert Stone, M.D.
Bloomington Herald Times
Guest column
April 25, 2008
Nationally, the week of April 27 to May 3 is Cover the Uninsured Week. Locally, many of the 883 GE employees and their families are getting closer every day to becoming uninsured. Since World War II, access to health care in this country has been based on employer-sponsored insurance, but the percentage of workers covered by their employers peaked in 2001 at 65 percent and has been dropping ever since. The projections are that in a very few years less than half of Indiana workers will have coverage through their work. We’ve heard about the problems the auto industry has in paying for health care, but small businesses are feeling it even more, dropping their coverage at an even higher rate. The problem of the uninsured is not just “their” problem, it’s “our” problem. We are all just a layoff, a plant closing or a divorce away from being uninsured.
To make matters worse, we have a new epidemic of under-insurance. From 2000 to 2006, insurance premiums rose 87 percent while earnings increased only 20 percent over that same six-year period. The national average cost is now $1,000 a month for family coverage. While premiums have soared, deductibles and co-pays have gone up, too. In the desperate attempt to find a policy with affordable premiums, the fine print becomes crucial. For example, the official plan offered to Indiana University students has an annual maximum benefit of $75,000 per injury or illness. You can spend that much in one week in the intensive-care unit!
It is becoming clear that our current medical economic situation is unsustainable, with medical costs rising faster than inflation, insurance premiums rising much faster than earnings, while the number of uninsured just keeps rising. We don’t even need to go into the moral dimension of the richest country in the world allowing a rapidly growing number of its people to live under Third World medical conditions.
Taking into account that costs are out of control, how can we possibly contain them? The essence of insurance is that the greatest efficiency is achieved with the largest risk pool. The essence of bargaining for good prices is the use of bulk purchasing. The most cost-effective medical care is preventive care. How can you incorporate all that in one solution? By setting up an all-inclusive system that brings everyone into one big risk pool, in other words, a universal system.
How can we run a universal system in the most cost-effective way? The government will have to be the paymaster. Doctors and hospitals should stay private and independent.
Where is the model that we can use? Our 40-plus years of experience with Medicare. In the mid 1990s, when officials in Taiwan decided that their market-based health insurance system was failing, they looked at the experiences of other countries around the world and ended up with a system very much like our Medicare, but for everyone, not just those over age 65.
Is that socialism? I hardly think so. If Medicare is not socialism for everyone over age 65 right now, why is it socialism if we cover the rest of us? Is it any different from our “socialized” police force or fire department?
Is Medicare perfect? No, but it is a solid foundation to build on. Do you see long lines of seniors waiting outside of doctors’ offices around town? No, waiting lines are not a problem. Do Medicare patients get second-rate care? No, quality is no worse in Medicare than private insurance, and in many ways better.
Cover the uninsured? Aid for the under-insured? And those at risk of losing their insurance? That’s getting to be about everyone under Medicare age. Let’s cover everyone. Medicare for all!
This guest column was written by Robert Stone, M.D., director of Hoosiers for a Commonsense Health Plan, and state coordinator, Indiana chapter, Physicians for a National Health Program.