Health care tipping point, redux
By Dr. Howie Wolf
Daily Camera (Boulder, Colo.), Nov. 28, 2010
Nearly five years ago the Boulder Daily Camera published my Guest Opinion article, "What is 'The Tipping Point' for American's Health Care Non-System?" There is a widely read book by Malcomb Gladwell called "The Tipping Point," where the author points out how so many societal changes seem to happen quickly and unexpectedly. An example given was the sudden fashion frenzy over "Hush Puppies" for cool shoes in the fifties.
But social movements and reform also may reach a "tipping point" wherein it is accepted by most people that something needs to give. The civil rights movement and subsequent laws came into being partly because most of society could not tolerate racial inequality. There have been countless marches for and against various causes when a group of people reach their tipping point. Howard Beale, who played Peter Finch in the movie "Network," utilized his famous line: "I'm mad as hell and I'm not going to take this anymore."
As a family physician that has practiced in Boulder County for 48 years, I feel our inadequate health care system is significantly closer to a "tipping point" than in 2006. I see more patients who are uninsured or underinsured, many due to layoffs in our sluggish economy and the inability of business owners to continue paying exorbitant costs to provide employees with health care benefits.
Nationally, there now are nearly 60 million uninsured Americans compared with the 46.8 million cited in my 2006 article. Further, nearly 45,000 of our citizens die annually because of lack of or delayed access to care. That number was 18,000 in 2006. These shameful statistics represent not just numbers, but fellow Americans: our parents, brothers, sisters, other relatives, and friends.
Despite spending more per capita for health care than other country, our statistics for longevity, maternal death, and infant death rank the United States in 37th place according to the World Health Organization.
Although there are those who cried "socialism" when a government health reform program was proposed, the new Patient Protection and Affordable Care Act was signed into law by President Obama in March, 2010. It is far from perfect but PPACA does begin to address some significant issues, mainly some of the egregious actions which have been the modus operandi for private health insurance companies. The new program reverses such policies as the exclusion of applicants with pre-existing conditions, dropping coverage for families whose health expenses are too high, and not allowing coverage in families to go beyond age 19, even for college students. In the future this new law will extend coverage to 32 million Americans currently underserved, provide coverage for most preventive services, and improve end-of-life care.
Sixty percent of Americans actually favor a tax supported, government-run health system, according to a Pew Research poll. All industrialized countries have various types of insurance plans, but none except America permits insurance companies to profit from basic health care policies. The lobbyists for insurance and pharmaceutical companies will influence our elected officials to resist movements toward a public option or single payer type plan. Such reform would certainly be more economical and efficacious than our present dysfunctional non-system.
In my view, health care reform in the near future must focus primarily on insurance and pharmaceutical company reform. That Americans pay as much as 80 percent more than Canadians for the same prescription drugs is inexplicable without using the word "greed." Insurance companies take 25-33 percent of our premium dollars for operating expenses, salaries, including as much as $30 million annually by some CEO's.
There are those who say: "Let the market work. Competition will drive the prices lower." Since the introduction of "managed care" in the early nineties, this credo has been proven untrue. Insurance premiums, deductibles and co-pay costs have escalated at unconscionable rates. Private insurance companies do not feature oversight or accountability, both required with any government-run health care system. Incidentally, our own "socialist" health programs -- the VAH and Medicare -- remain popular and operate at about a 3 percent overhead.
A recent international study revealed that 20 percent of U.S. adults had serious problems paying medical bills. The other ten countries in the survey reported less than ten percent! Even Americans with insurance spend more than citizens of other countries in out-of-pocket costs. Most Americans are frustrated with what their insurance company pays, and do not understand their so-called explanation of benefits.
Each of us knows many who are uninsured or underinsured. Most of us recognize how unfair our health care non-system can be, able to deliver excellent care to many, but marginalizes those who cannot pay. The U.S. system forces physicians and other providers to make unethical choices -- offering services, prescription drugs, imaging studies, and referrals only to those who can afford them.
What can we do to stem the tide of the tipping point? We must become activists to support health and insurance/pharmaceutical reform efforts. We need a health system that includes all Americans and funds care fairly. There should be preventive care, lifetime enrollment, and choice of providers of many types, and no exclusions for pre-existing conditions.
If the federal government cannot make these changes, then individual states may be able to take the initiative. Good news: The newly elected governor of Vermont, Peter Shumlin, ran on a single payer platform for his state.
For more information check healthcareforallcolorado.org
Howie Wolf is a physician in Boulder.