Rationing is not the only alternative

Star Tribune, Feb. 7, 2011

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."


In a recent commentary (Opinion Exchange, Jan. 23), Dr. Virginia Dale told readers that they must choose between universal health insurance and rationing.

As a physician, I agree that we must get health care costs down if we're going to achieve universal coverage, but I strongly disagree that the only way to do it is to ration.

There is another viable and proven option: a single-payer or regulated multipayer health care system, such as exists in every nation in the Organization for Economic Co-operation & Development except the United States and Mexico.

The average OECD nation spends 6 percent to 10 percent of GDP on health care; we spend 17 percent. Their per-person spending averages $3,000 to $5,000 a year, compared with $8,000 in the United States.

We could save huge sums -- more than enough to insure the uninsured -- by cutting the administrative waste and executive profit in our system, and by collective bargaining to lower the price at which drugs, devices and medical services are sold in this country.

The true "elephant in the room," to use Dale's metaphor, is the fact that our health care system has been "privatized" by an insurance industry more intent on lining its pockets than on ensuring that the American people get the public service and care that they pay for.

HMOs reap a hugely profitable business by denying and limiting care (a more severe form of rationing than exists in any other OECD nation) and by taking upward of 20 percent from every premium dollar and even tax-funded programs to pay excessive salaries to people who provide no patient care whatsoever.

The 80 percent they are obligated to spend on your health care is called their medical loss ratio. Nice, huh?

In a recent survey, 23 percent of Americans felt they were inappropriately denied care, compared with 4 percent of Canadians.

It was revealing to look at the political cartoons in the same Opinion Exchange section in which Dale's commentary appeared.

One showed an American with a letter labeled "DENIED" and a caption stating: "50% of all Americans under 65 have preexisting medical conditions that may prevent them from getting insurance ... ."

The next image showed a smirking lawmaker in his Washington office with his feet up. The caption: "100% of the 249 congressmen voting to repeal health care have their health care plan paid for by those same Americans ... ."

And that is the truth.

The more somber note is that even if the American depicted in that cartoon has health coverage, with the loss of a job or the onset of a major illness that causes the loss of health benefits, he or she may easily join the millions each year who are bankrupted by medical bills.

That doesn't happen under universal coverage or a single-payer system.

Providing universal health care is not socialistic. It is the pooling of resources by a highly ordered social structure to provide for the common good. Some call it civilization.

Think about it: This is how we fund all of our public services, including fire, police, water, education, libraries, sewage, parks and recreation, and highways. Health care would seem the most essential of public services.

Why do some people call it "socialized" (like it is a dirty word) only when we apply the term to medical care, but not to the other public services that we fund and use daily?

Tommy Douglas, who was voted the "Greatest Canadian" in 2005, nearly 20 years after his death, for bringing a universal health care system to his nation, was a humble clergyman dedicated to the importance of economic democracy and the "social gospel."

If only our politicians had an ounce of his moral integrity and commitment to serving the nation's best interests.

It is highly misleading to tell the public that our choice is between continued high numbers of uninsured people or rationing.

Our choice is continued high numbers of the uninsured vs. cutting the enormous administrative waste and corporate profit out of our system with a single-payer system that allows us to lower the prices we pay for medical services, drugs and devices to levels paid in other countries.

As taxpayers and voters, we need to demand accountability, and we are not getting it from our current HMO system. The industry has had more than 20 years to get it right and has failed miserably to do so.

 We are getting fleeced. As Paul Wellstone said: "We all do better when we all do better" -- not when the CEOs and executives of medical care organizations do obscenely better at the expense of our national health.

Ralph S. Bovard is a steering-committee member of Physicians for a National Health Program-Minnesota Chapter.