American health-care system is ripe for reform
By Ron McAllister
Portsmouth Herald News
August 13, 2008 6:00 AM
We hear a lot these days about universal health care and single-payer insurance schemes. It’s what they have in Canada.
Health insurance in the United States is not universal (except for those over 65) since as many as 15 percent of the total population (47 million people) are uninsured. It is also not a single-payer system. In single-payer systems, both the collection of funds and the reimbursement to providers are the responsibility of a single agency — the government.
Interestingly, America’s primary health insurer is the federal government. By some estimates, one out of every three Americans (as many as 100 million people) already obtain their health insurance from the federal government. Many of these (e.g., military service personnel and veterans) have a form of universal-single-payer insurance, but most of the rest of us shop in the “free market” for health care.
If you were to examine health care in France, Germany, Great Britain, Japan, the Netherlands and Switzerland, you would find that each has virtually 100 percent (universal) coverage. You also would find that medical care is provided more cheaply in each of these countries than it is in the United States. (The following data are from http://www.npr.org/news/ specials/healthcare/healthcare _profiles.html).
Per-capita spending on health care in the U.S. is nearly double what it is in the other six countries ($6,402, compared to an average of $3,314 in the others).
Cost to the U.S. government is also substantially higher ($2,884 per person) than that paid by the other six governments ($1,928 on average).
Further, while most developed countries have supplementary private insurance options, private insurance costs are higher here than elsewhere ($2,676 per person in the U.S., paid more or less evenly by employers and employees).
Out-of-pocket expenses for consumers also are greater in the U.S. ($842 per person here, compared to $442 in the other six countries).
Why is medical care so expensive in the U.S. compared to the rest of the developed world? There are many reasons, but the sheer complexity of our system and the massive bureaucracies necessary to make it function are key. Administrative costs contribute in a substantial way to the expense of health care without materially affecting its quality. The cost of providing health care in this country must be reduced. Having a single source for the collection and disbursement of funds would have that effect.
In other countries, costs are kept down by a variety of cost-containment strategies (e.g., Britain’s National Institute for Health and Clinical Excellence advises which high-cost treatments should be covered). Further, revenues in Europe are enhanced by higher taxes, which substitute for user fees.
The consequences of a more affordable and more efficient system are readily apparent. Universal health care correlates with better health and longer life-spans for citizens. Life expectancy at birth in the six countries mentioned is greater than in the U.S. by an average of more than two years.
So why haven’t we adopted some form of universal health care in the United States?
This is a complicated question affected by a number of factors including the influence of large corporations, the financial interests of providers, the weight of our tradition of individualism, and our general aversion to “socialized medicine.”
Ironically, the Veterans Administration with its publicly owned hospitals and government-employed medical staffs is a form of socialized medicine, while the Canadian system in which doctors are independent practitioners rather than government employees is not.
The current health-care system in America is ripe for reform. It is bankrupting families, draining the federal treasury, and failing to optimize citizens’ health. A unified and universal health-care system could be both simpler and cheaper than our current hodgepodge of complex plans and multi-layered bureaucracies.
All Americans deserve health care that is at least as good as what the rest of the world already experiences.
Ron McAllister is a sociologist and writer who lives in York. He is currently a candidate for the Maine House of Representatives.