Many inconvenient truths on health care
By Dr. Stephen Sokol
Sun Journal (Lewiston, Maine)
Jul 26, 2009
Health care in America is a shambles and will, like a critically ill patient, likely collapse if not properly and promptly attended to.
We are told we have the best health care in the world, yet when we are ranked by the World Health Organization, we are 37 of 137 countries, just above Cuba and well below the United Kingdom and Canada, both of whom have single-payer systems. In the same ranking, we are 32nd in the world in infant mortality, 24th in life expectancy and 54th in fairness, which measures equality of access and quality of health care across religion, race or ability to pay.
Almost 50 million Americans are uninsured and a similar number are underinsured, 75 percent of whom are employed. Thirteen percent of Mainers live below the poverty level and over 9 percent lack health insurance. A similar number are underinsured. The Institute of Medicine of the National Academy of Sciences has shown that 50 Americans die daily because of lack of health insurance. Imagine if that figure were the fatalities of our troops in Iraq and Afghanistan. Yet we expended 17 percent of our gross national product, $2.4 trillion, on health care in 2007, twice as much as most other industrialized nations and still achieved significantly lower quality. We are now in the throes of a severe recession and more Americans, as they lose their jobs, lose their health insurance. Medical bills cause 60 percent of bankruptcies and 75 percent of these folks are insured.
Why? Private insurance companies are driven by profit and expend 16 percent of their income on overhead and therefore are stringent about what they will and will not cover. Most people with underlying common chronic problems such as hypertension and diabetes are excluded. In contrast, Medicare spends 2.1 percent and Canada 1.2 percent on overhead and there are no exclusions. We spend over $7,000 per-person, per-year, while Canada spends $2,500 and achieves better results.
We have been told that free market forces and competition will correct these problems, yet since the inception of the private health insurance sector during World War II, costs have only accelerated. When you have a heart attack or appendicitis, it is hard to shop around for price. These companies are not market-driven. They are for-profit. Keeping the present system of myriad private insurers only guarantees the status quo.
Remember the health care sector spent $450.7 million on lobbying alone in 2007 — and that was not to ensure equal access for all. Pharmaceutical companies spent over $14 billion on advertising, not only to doctors but to everyone. Remember the slogan on those TV ads, “Ask your doctor if … is right for you.” Some of those very drugs are quite hazardous. Hospitals, purporting to exist only to guarantee us excellent care, spend enormous amounts in competition for their “market share.” Just check the ads on TV and in the newspapers. Sadly, doctors have also joined in.
A single-payer system would eliminate many of these inequities by significantly reducing overhead, regulating costs and eliminating much of this frivolous waste. Good examples of excess here in Lewiston are the presence of three CT scanners, two MRI scanners and a part-time PET scanner, more hardware than available in any developing nation. Excess equipment ensures excess procedures.
We also now have a cardiac surgical unit, which cost millions, while there is one of the best in the country 40 miles down the road. A criticism of a single-payer system has been long waiting times. Having had personal experience in Canada and Germany, I can state no critically ill or urgent patient has been refused immediate, excellent care. Unlike here, where over 300,000 yearly are denied access, no one is turned away because of inability to pay as there is true universal coverage.
In 1995, Taiwan changed from a U.S. type system in which only 60 percent of the people were covered to a single payer system. By 2001, 97 percent were covered with only a minimal increase in cost.
I agree with the Founding Fathers, who believed that “all men were created equal” and that we all had “certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.” Now I wonder how preserving these rights are possible for those of us who are sick and cannot get proper care. A single-payer system similar to Medicare, which has made a huge impact on the health of the elderly, can achieve these ends and keeps with the values that America and Americans espouse.
Health care is a right for all, not a commodity for the privileged.
Dr. Stephen Sokol is an assistant professor of geriatric medicine at the University of New England and a volunteer with Doctors Without Borders and the International Rescue Committee. He lives in Lewiston.
http://www.sunjournal.com/node/35624/