Let’s wise up on the costs of health care

By Rod Watson
The Buffalo News, Feb. 18, 2015

The spat between doctors and a health insurer over which anti-addiction drug patients can get raises again the fundamental health care question Americans answer one way, and the rest of the world answers another: Whom do you trust?

While the rest of the industrialized world puts its faith in the single-payer system, and spends much less as a result, we spend 50 percent more while relying on insurers and not even insuring everyone.

Not that disputes like the one over Independent Health’s switch to a cheaper drug – which it says works just as well with fewer risks – would disappear under single-payer.

Under the model pushed by Physicians for a National Health Program, there would still be restrictions to curb unneeded costs. But instead of doctors versus insurance companies, it would be doctors versus the government, said Dr. Robert Milch, retired medical director at Hospice Buffalo and part of the local PNHP chapter.

That model would not be “socialized medicine,” in which doctors work for the government. It would be more like Medicare, in which the government simply pays the bill for care provided by private-sector doctors.

There would still be cost constraints, said Milch. There also might still be some insurers to cover care beyond a certain baseline, such as cosmetic surgery, said Dr. Kathleen Grimm, who heads the local PNHP chapter.

The difference? Patients wouldn’t have to worry about whether profits to fuel executive salaries, new facilities and a medical-equipment arms race were the motive behind medical decisions.

Peer review, global budgets and similar mechanisms would hold down costs while eliminating a huge layer of bureaucracy that eats up dollars while not performing a single medical procedure. That bureaucracy is why we spend nearly 18 percent of gross domestic product on health care, while our competitor nations spend less than 12 percent.

And what do we get for all that extra spending?

In a Commonwealth Fund ranking of 11 industrialized nations, the United States was dead last when it came to access, quality and cost. In a similar World Health Organization analysis, the U.S. ranked 37th, well below competitor nations.

Single-payer would give us less fragmented, more streamlined care, with the government using its clout to hold down prices and put money into direct care rather than bureaucracy, Grimm said. It would make health care a “public good,” similar to police and fire protection.

“We don’t have health insurance in that way, but we could,” she said.

We could, once we get past the fearmongering over “government takeover,” “socialized medicine” and “rationing,” which already exists based on economics but is rarely acknowledged.

Insurance companies talk about “evidence-based” medicine to justify decisions. But the evidence is clear that we’re not benefiting from a system in which prior-approval reviewers, lobbyists, CEOs and others standing between patients and doctors skim off nearly a third of all health care dollars while administering no care. The evidence shows we spend far more to get far less than countries relying on single-payer.

Using the industry’s own rationale, it’s time to change prescriptions.

Rod Watson is the News Urban Affairs Editor at The Buffalo News. He can be reached at