It’s time for business community to take stand on health reform

By Hirsh Cohen
Business Courier of Cincinnati
Friday, December 4, 2009

The latest numbers are staggering. A new Harvard study in the American Journal of Public Health reports that nearly 45,000 deaths occur each year in the U.S. because of the lack of health insurance. That’s a death every 12 minutes.

Half of middle-class workers say they or a family member postponed, cut back or skipped needed care because of its cost, according to a June 2009 survey.

In my many years in public health, I am personally aware of dozens of people whose health suffered because they lacked insurance coverage. They put off care until their condition was critical, sometimes with catastrophic results.

Beyond the human toll, our fragmented and dysfunctional health system hurts us financially. Health care costs and insurance premiums are skyrocketing, unsustainably straining businesses and workers.

Sixty-two percent of personal bankruptcies are now linked to medical bills and illness, and more than three-quarters of those bankrupted had insurance when they got sick. Premiums for employer-sponsored coverage have more than doubled over the past decade.
Something’s terribly wrong

Regrettably, the bills emerging in Congress would do little to reverse these trends. They simply don’t go far enough.

The business community should be alarmed that we are getting so little return for our health care dollar. Our insurance premiums go up, but coverage deteriorates. We face more co-pays and deductibles, claim denials and hassles. In addition, the costs of providing care to the uninsured and underinsured are borne by a smaller pool of insured workers. It is estimated that almost 25 percent of our premiums fund Medicare, Medicaid and uninsured shortfalls.

The U.S. spends twice as much per capita on health care as any other Western nation but has much less to show for it in medical outcomes. We are No. 1 in dollars spent but 37th in performance out of the 191 countries tracked by the World Health Organization, placing us below Colombia, Saudi Arabia and Portugal.

Why? A big part of the answer is that we rely on a private insurance model. For all its net value, the system saddles us with enormous bureaucracy. (Approximately 31 percent of every dollar is spent on administration and profits instead of going toward care.)

In addition, we are focused on a medical services model and not a health care model; incentives exist to treat on a fee-for-service basis with little or no incentives for prevention and primary care.

The proposed legislative initiatives will help improve some access and possibly some costs, but the execution will be difficult and time-consuming. An expanded and improved version of Medicare would be more cost-effective and equitable. Some lawmakers say such an approach is unrealistic, but 44 years ago the same was said about Medicare.

My years of work in Canada convinced me that a single-payer model is workable and effective. It’s true that system is stressed and needs significant improvement, but the funding is more logical and no one in Canada declares bankruptcy because of medical costs. An American single-payer system would have its own features and enjoy better funding.

It is time that the business community take a strong stand to ensure that our nation joins the rest of the industrialized world and guarantee seamless health care coverage to every man, woman and child in America. That means a publicly financed, but privately delivered program of single-payer Medicare for All.

Let’s get serious, Cincinnati business community.
A Better Way

The benefits to businesses and the work force under a single-payer program:

• Both employees and employers would get more health care and less bureaucracy for every dollar spent.

• Medical bankruptcies would become a thing of the past.

• Employers would have a stronger incentive to move part-time workers to full time.

• With increased access to preventive care and wellness programs, employees would be healthier and miss less time from work.

• Employers would see a drop in liability insurance and workers’ compensation costs, an end to contentious negotiations with insurers, a reduction in retiree benefit costs and an end to complaints by employees over rising premiums and expenses.

• Finally, an improved Medicare for All would allow costs to be controlled and predictable, eliminating a major source of business uncertainty and a barrier to planning.

Cohen holds a master’s degree in health administration and is a fellow of the American College of Healthcare Executives. He was the assistant health commissioner for Cincinnati and has held health care executive positions in both the U.S. and Canada.