Proper health care requires everybody in the same boat

By George Jolly
The Saratogian (Saratoga Springs, N.Y.)
Sunday, February 14, 2010

Health care reform has derailed and is sitting beside the tracks.

The proposals that came out of Congress are patchworks of policies which try to alleviate some of the most egregious failures of our present healthcare “non-system,” such as limiting the power of insurance companies to refuse to cover those with pre-existing conditions.

But those stalled efforts fell far short of what is needed:  Twenty-million people would remain uninsured. The system would be more complex than ever. These reforms would cost an extra trillion dollars over the next 10 years and contain no effective means of reducing the rapid rate of growth of health care expenditure. More middle-class families would face financial disaster as insurance companies issue policies inadequate in serious illness. The mandate to buy insurance would push huge sums into the hands of the already powerful private insurers.

What should be the essential features of the future American health care finance system?

- We need to have everybody participate. That is the way insurance works — you spread the risk of illness across as many people as possible.

- We need simplicity, ease of administration, ease of enrollment and a system not affected by changing jobs or being laid off.

- It should cover all necessary medical care.

- It should allow choice of physician and of hospital.

- We need to curtail rising costs. The greatest waste in the system right now is created by enormous bureaucratic complexity. Future rises in costs should be managed system wide, with input from providers and the public. It is crazy to let Congress micro-manage health care expenditure.

It should be financed through a graduated income tax, because illness doesn’t check to see if you are wealthy or poor, employed or unemployed.

Such a system already exists in our traditional Medicare.

As a citizen, I know I’m automatically included at age 65. The paperwork is minimal. I can use any doctor or hospital. It is clear what is covered and what is not. It runs with an overhead of 5 percent instead of the 15 to 25 percent of commercial insurance. Payment policy is controlled by a federal agency under a budget set by Congress.

Medicare is costly, paying for care of the oldest and sickest people in society. We have caused that by allowing private insurance to “cherrypick” the healthiest, lowest-cost working people. Every healthy person brought into “Medicare for all” will reduce the per-patient cost. Elimination of the multiplicity of insurance companies and the use of global budgeting of institutions like hospitals will result in an estimated savings of $400 billion yearly, enough to pay for all the uninsured, and improve the quality of coverage for both present and new Medicare enrollees.

Shouldn’t we expect more from our elected representatives, the Congress and the president? Shouldn’t we insist that they place the interests of the American people ahead of the special interests of insurance companies and drug companies? A workable solution won’t emerge unless each of us makes it clear to our elected officials that we want a system based on the principles listed above.

So, if no reform comes out of Washington this year, we may have been given a chance to do it right. Our first consideration ought to be a “single-payer” Medicare for all.

George Jolly is a geriatrician with Saratoga Medical Associates in Saratoga Springs.