Posted on June 26, 2006

Bring on National Health Insurance


By Vincent P. Maconi
Delaware On-line, The News Journal, 6/25/06

Editorial for Single-Payer

When Gov. Minner nominated me to be Delaware’s secretary of Health and Social Services in January 2001, a few eyebrows were raised. I’m not a physician, nor had I spent any of my government career in health care. But if coming into the job without a lifetime of experience required me to climb a steep learning curve, it also allowed me to enter the field without preconceived notions.

It quickly became clear to me that this nation needs universal health care. America’s health care system, despite the efforts of millions of dedicated health care professionals, is broken. Frankly, nothing but national health insurance makes sense.

I might seem an odd official to be championing national health insurance, given that many of the times my name has appeared in this newspaper over the past few years, it has been to defend efforts to control costs of the state’s largest health care program, Medicaid. In fact, attempting to get my arms around state spending has given me an excellent vantage point from which to see the system’s problems — and the only logical solution.

Phil Soule, Delaware’s long-serving Medicaid director who recently retired, once told me that in years past, Medicaid was all about making people healthier. Now it’s all about who is paying the bills. He’s absolutely right, and sadly that focus extends to just about everyone else in the health care arena.

Everybody — doctors, hospitals, insurance companies, government officials, and patients themselves — spends too much time administering or coping with the system and figuring out who will pay for a service — and not enough time figuring how to deliver service better or to more people. No one spends enough time figuring out how to make people healthier.

Having spent my life in politics and government, I’m a realist. I know that the current president and leadership in Congress have no interest in a universal health care system. Those who don’t oppose it on philosophical grounds would likely argue that the country can’t afford it.

I could make the argument that the world’s wealthiest country should guarantee health care to all of its citizens. That’s the kind of society that I want to live in. But for those who aren’t moved by that aspiration, there’s every likelihood that a national health care system would not only pay for itself through a healthier populace, it would also cost less in dollars than what the nation pays for health care now.

Our money’s worth

The literature of health care is replete with studies comparing this country’s health care with other developed nations, all of which have national health care systems. Virtually every one shows the same thing: The United States spends more money per capita than any other country, yet is less healthy.

We’re paying the highest prices, but getting the lowest quality.

Look at a health spending analysis by the Organization for Economic Cooperation and Development, comprised of 30 of the world’s leading industrialized nations. Examining the 2002 data, the OECD reported that the United States per capita health care spending of $5,267 was not only 53 percent higher than that of the second-highest country, Switzerland, it was almost two and a half times the average per capita health care expenditure of all the other developed nations.

To put it another way, the United States is spending nearly 15 percent of its gross domestic product (the combined value of all goods and services produced by a nation) on health care. Only Switzerland and Germany also spend as much as 10 percent.

The United States pays much higher prices than other countries for hospital stays, drugs and physician services.

Administratively, we’re awash in red tape. Health administrative costs in America are triple what they are in Canada, which has universal health care.

What results are we getting for paying that huge bill? The system hasn’t produced health coverage for all. Even in Delaware, which has one of the lowest rates of people without health insurance in the country — thanks largely to the huge investments Gov. Minner and the General Assembly have made in the state’s major health care programs, Medicaid and the Children’s Health Insurance Program — 10 percent of our residents lack any form of coverage.

Nationwide, that figure is more than 15 percent. Many of the uninsured are the working poor, who earn too much to receive government aid, but not enough to afford insurance.

Let’s also examine two universally recognized measures of national health: life expectancy and infant mortality. A quick surf on the Internet reveals that, among those 30 OECD countries, the U.S. life expectancy of 76 years exceeds that of only seven: Mexico, South Korea, Turkey, and the former communist nations of Slovakia, Poland, Hungary and the Czech Republic.

People everywhere from Iceland to Australia live longer than we do in America.

Last November, ABC News reported that the United States ranks 28th in the world in infant mortality — not just far behind Sweden, France, Japan and Germany but behind Cuba too. The United States is on a par with Croatia and Lithuania.

If the lack of support for health care reform by the president and Congress isn’t puzzling, the lack of business support is. You can’t pick up a newspaper without reading about another company cutting back on health coverage for employees or pensioners.

Certainly, the business community has historically preferred less government. But given that private businesses are having the same difficulties paying for health care as the public sector, I predict that over time, more business executives will come to see that health care is better left to government.

In today’s global economy, American companies are at a competitive disadvantage when up against businesses in other nations whose out-of-pocket health costs are zero. It’s a mystery why General Motors and other automobile companies, with their well-publicized dilemmas regarding health care overhead, are not leading the call for national health care. Small businesses too are experiencing increased difficulty in locating affordable health insurance.

With all due respect to those passionate advocates for a single-payer system in Delaware, I doubt this state could do it alone. Were Delaware the only state to adopt universal health care, individuals from surrounding states (if not the entire country) would flock here, especially the sick and uninsured. Delaware would go broke quickly.

Universal health care likely wouldn’t work in Delaware alone unless it figures out a way to prevent individuals from moving to this state to take advantage of the health care system — something I’m sure the Supreme Court of the United States would find problematic.

Whether the president, Congress and business are uninterested or opposed to a nationwide health care system, the country nevertheless is going to get there sooner or later. The only question is whether it gets there accidentally or on purpose.

Right now it’s getting there accidentally. As fewer private businesses offer health insurance to employees, the percentage of the population that receives health care from government programs continues to rise. The New York Times recently projected that by 2014, more than half of Americans will receive their health care from the government. So let’s get there on purpose.

Taiwan did exactly that 11 years ago, switching from a system similar to that of the United States to universal health care. Within six years, its uninsured population declined from over 40 percent to less than 3 percent, without an increase in costs.

As Winston Churchill once said, “Count on Americans to do the right thing, after they’ve tried everything else.” It’s time to end the irrationality of this health care system and move to national health insurance.

Vincent P. Meconi is secretary of the Delaware Department of Health and Social Services.