Posted on September 11, 2009

Health reform should start with moral question


The Missoulian
Letter to the editor
Thursday, September 10, 2009

Amidst the give and take of the health care reform discussion is an underlying basic moral imperative: Does a wealthy country like the United States have an ethical obligation to provide access to health care to everybody?

If the U.S. made the moral choice to provide universal coverage, like other industrialized nations, then we too could design a fair, efficient and high-quality health care system for all Americans.

So the first question that must be answered by policy makers is, “Do we want to live in a society that lets tens of thousands of our neighbors die each year, and hundreds of thousands face financial ruin, because they can’t afford medical care when they are sick?”

Once answered that morally everybody should have a basic human right to health, aided through a system of health care, that is comprehensive, simple to administer, of lower cost, and universally available, we can move to the next step.

The concept of a unified system that works the same for everybody doesn’t necessarily equate to a single-payer system, although this seems to be the simplest and best. There are multi-payer systems that provide fairness and the administrative simplicity of a single payer structure: all patients treated the same and all the payers follow a coordinated set of rules and forms, and all providers fees adhere to a unified payment schedule. A unified system makes it easier to use digital record keeping. It eliminates cost shifting and an incentive for preventive health measures.

The fragmented system we have hasn’t worked. Financing health care must be a non-profit endeavor. A unified system creates a powerful political dynamic for managing cost. Universal coverage enhances health care results by improving the overall health of a nation. Incomplete coverage is a key reason 22,000 die every year from diseases that could have been treated if they’d had health insurance.

Because administrative costs and unnecessary care, combined with perverse incentives, are the major causes of the expense, the concept of a single payer system is mandatory. This is an anathema to free-market people, who are misleading the public by negative advertising, with denigration by politicians and others, labeling it “socialized medicine,” and “government interference.”

To get the truth out, there should be a new intense advertising campaign to educate the public about the benefits of this approach. A single payer system could be run by a federal board, independent of the government, appointed by the president and confirmed by the Senate. It could function with assistance of health care experts and be immune to political interference. Regional entities under the board’s aegis could manage the delivery of health care. Unnecessary care could be monitored so the link between income and generated procedures and tests could be curbed. There are many options for reimbursement to providers: capitation, global payments, salary system, pay for episodes of care, rewards for improved outcomes, and pay according to episodes of care. It’s interesting that 30 % of U.S. physicians are already on salary. Tort reform must also be addressed to eliminate the high cost of liability insurance, through a review panel of peers for malpractice claims.

All of this could be done by not spending any more than what we do now. It is more likely there would be a huge reduction in health care spending. It just doesn’t make sense to continue the partisan pursuit of complicated individual interests. Everyone needs to proclaim that there exists a moral imperative; that it does mean providing access to health care for everyone. It is relatively common sense to then formulate a government funded, unified system, with nonprofit financing and coverage for every citizen - a single-payer system.

Richard A. Damon, MD