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Changing our health care system will take time

By Jack Bernard
The Augusta (Ga.) Chronicle, Dec. 10, 2016

"Not everything that is faced can be changed, but nothing can be changed until it is faced."
– James Baldwin

A conservative friend mentioned to me the other day that he agreed with Mike Huckabee, a big Donald Trump supporter, on health care. The problem with Americans is that we eat too much, exercise too little and do not know the cost of health care services. With the nomination of U.S. Rep. Tom Price, an advocate of more personal responsibility and less government, to be secretary of the Department of Health and Human Services, several thoughts came to mind.

True, Americans have unhealthy lifestyles, as do other wealthy nations whose citizens smoke and drink more than here. But there are problems in our insurance and delivery system as well.

And health insurance certainly does insulate the patient from costs. That is what all insurance is supposed to do.

Price, Huckabee, House Speaker Paul Ryan and other reactionaries are subtly building on the health care establishment’s historical position (“We have the best health care in the world”) just get the government out of financing it. In other words, the problem is the patient/public and our government.

But how do more objective sources view our system?

The Journal of the Royal Society of Medicine (the United Kingdom’s counterpart to the American Medical Association) did a comparative study in 2011 of 19 countries and found: “In cost-effective terms, i.e. economic input vs. clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates.”

Our own National Research Council and Institute of Medicine issued a joint study in 2013 that detailed many problems with our lifestyle, but it also criticized our access problems, stating that 50 million residents (with the Affordable Care Act, now 30 million) had no health insurance. All nations studied did better than the United States, except Turkey, Chile and Mexico.

The report criticized the private-public-provider-payer morass that constitutes American health care delivery and financing, stating that U.S. patients do not receive the care that they need and receive care that they do not need. It further indicated that “Americans do not experience optimal quality when they do receive health care” due to the “fragmented” nature of our system, creating “inefficiencies and coordination” problems other nations do not have.

The report also referred to a Commonwealth Fund study that found Americans were more uncertain than others that their treatments would be adequate if they were seriously ill.

The report also found that Americans already had higher deductibles, copayments and out-of-pocket expenses vs. other nations, with 40 percent of those younger than 65 with insurance reporting access problems due to cost.

As opposed to what many on the right say, the study found that our citizens were more likely than other countries to experience delays when seeing a physician for serious ailments. The report also stated that other studies have shown hospital readmission rates to be higher here, an indicator of lower-quality care.

All told, it is a damning indictment of how we get health services in the United States – the result of our excessively expensive but deeply flawed system.

What can we do about the situation? First, stop buying false arguments about the only problem being the patient. We have identifiable access, cost and quality issues. And the solution is clearly not what Price and Ryan suggest: eliminating Medicare as we know it (via vouchers), cutting Medicaid (via block grants) and doing away with Obamacare (and throwing 20 million Americans to the wolves). Gallup surveyed people earlier this year and found 77 percent were happy with Medicare, a figure much higher than those with employer-based insurance.

Earlier this year, Gallup found that the majority of Americans do in fact want a national health plan to cover all. With Medicare as the sole payer, not only can costs be controlled and access guaranteed, but we can institute quality measures. The website of Physicians for a National Health Program (www.pnhp.org) details single-payer specifics, including costs, benefits and financing.

Will this grand plan happen tomorrow? No, it will take time. But, if we push our legislators to look at facts, vs. the histrionics of TV entertainers such as Trump or ideologues such as Price, that day will eventually come.

The writer was the first director of health planning for the state of Georgia and retired as an senior vice president with a national health care firm.

http://chronicle.augusta.com...