F Y I - WHAT'S HAPPENING?
Health
Care for All?
We Americans like to see ourselves as Number 1, Numero Uno!
But in Health – and Health Care – we’re anything but. In fact, the World Health Organization ranks the US system as 37th in the world. Many other countries do a better job. Though we spend the most per capita on health care and have very advanced technology for those who can pay, our health status as a society does not reflect that. We’re only 28th in the world in life span, and our infant mortality rates are among the worst in the industrialized world.
WHY?
The problem seems to be that too many of our citizens don’t feel they can afford to go to a doctor. More than 8% of American mothers have no prenatal care at all before giving birth. In the countries that have healthier people than we do, everyone has health care. No one has to wait for an emergency or serious illness before they go to a doctor. They can go while problems are minor. And they don’t suffer bankruptcies from exorbitant medical bills, so they don’t have that to worry about. Only the US, of all the industrialized countries, is without universal health care.
Shared Responsibility Plans
Some countries, like France, Germany, Belgium, the Netherlands and Austria have hybrid public-private systems, a shared responsibility system. Employees, employers, and the government all contribute. They meet in a bargaining session with representatives from professional associations of doctors and other health care professionals to set fees. By this process, they are able to negotiate cost controls. Both workers and employers have mandatory payroll deductions, with the government chipping in for poorer individuals.
The World Health Organization rates the French system as the best in the world.
Key to the success of this system is the cost controls, agreed on by all the groups involved. Lack of cost controls is a major weakness of the US prescription drug plan, which is run by private companies that charge monthly premiums in addition to the prices of the drugs and are free to raise their prices at any time.
Single-Payer Plans
Canada, Britain, and Sweden have single-payer plans, in which all payments are made by the government. In Britain, the government hires the doctors and runs the hospitals. In Canada, doctors continue to have private practices and Canadian hospitals can be either for-profit or not-for-profit. The wait for service tends to be longer with these plans; sometimes Canadians cross the border to get faster service in the US, for which they pay. But everyone in Canada is covered.
Since the Canadian government negotiates drug prices with the drug companies, drugs in Canada cost about half of what Americans pay. Also, whereas 15% of US administration costs come from paper shuffling among different organizations, single payer administrative costs are much less than ours. So Americans pay more than Canadians. The annual cost per capita for Canadians is $2,389, compared with $5,711 per capita for Americans – about half as much.
In 1970, before their single payer-system started, Canadian health statistics were similar to those in the United States. Now, thirty-six years later, the differences are clear. For example, Canadian life expectancy is 80 compared with 78 for Americans. Infant mortality in Canada is less than 5 per 1000, compared to Americans’ 7.1 per 1000.
Historically, poor people have suffered more illness and died younger than affluent people. In Canada today, there is no relationship between income and mortality rates.
The Australian system is a mixture of public and private services, and Australians may choose either public or private care. Universal health insurance is provided through Medicare. The Australian government funds universal medical services and pharmaceuticals and research and gives financial help to hospitals and aged-care facilities. Providing the services is primarily the responsibility of the State and Territory governments. (http://www.dfat.gov.au/facts/health_care.html
State and Local Plans within the
US
Recognizing the need for universal health care, several individual US states – and even local jurisdictions – are experimenting with offering health care plans aimed at universal coverage.
Massachusetts’ plan, adopted in spring, 2006, is an experiment in trying to create universal health coverage through a shared responsibility format. Everyone must buy insurance; regulatory changes make this more affordable. The state specifies a basic set of health provisions that must be included in any plan. It has also designated a “Connector” – a marketplace of insurance plans from which individuals and business may choose.
In January 2007, Governor Arnold Schwarzenegger of California proposed a plan for bringing universal health insurance to all Californians. A year before, he had vetoed a bill that would have created a single payer plan similar to Medicare. Residents’ fees would have gone into a state fund that would have bypassed the insurance companies. His new plan forces everyone to buy health insurance, with financial aid to low-income families. It requires insurance companies to sell insurance to everyone at the same price and spend at least 85% of their premiums on health care.
Paul Krugman has called this plan "a complicated, indirect way of achieving what a single payer system would accomplish simply and directly." (New York Times column, January 12, 2007)
Several other states are exploring financing mechanisms for expanding coverage, especially for children. Most use some federal dollars. Some use dedicated funding streams, such as tobacco tax revenues or funds from the 1998 tobacco settlement. California is exploring a universal single-payer system.
The San Francisco Health Care Security Ordinance creates a health access program that offers comprehensive services to uninsured people at reasonable cost. Muskegan, Michigan, also has an extensive health access program.
The Allure of Privatization
In the US in recent years, privatization of many previously government-run services has been popular – hospitals, schools, and even prisons have been turned over to for-profit organizations to manage in the belief that they would do a better job. But at least one study showed surprising effects of hospital privatization on patient well-being.
Among 38 million adult patients in 26,000 US hospitals, the death rates were 2% higher for the patients in the for-profit hospitals than for the patients in the not-for-profit hospitals: the patients in the for-profit hospitals had a higher chance of dying while in the hospital or within 30 days of discharge.
The lead researcher, cardiologist P.J. Devereaux,* concluded that these rates were clearly linked to “the corners the for-profit hospitals must cut in order to achieve a profit margin for investors, as well as to pay high salaries for administrators.”
“To ease cost pressures, administrators tend to hire less highly skilled personnel, including doctors, nurses, and pharmacists…” he wrote. “The statistics clearly show that when the need for profits drives hospital decision-making, more patients die.”
*P.J.Devereaux, P.T.L.Choi, C. Lancetti, B. Weaver et al., Canadian Medical Association Journal, 2002, 166, no. 11, 1399-1405.
Possible US plans
It seems clear that Americans who can afford it are paying more than they should and that too many Americans are not getting the health care they need. The whole society suffers as many get no care or publicly funded hospitalization that could have been avoided by early care. Medicare benefits only those over 65, and Medicaid helps only the indigent. Too many Americans are being bankrupted by huge medical bills. We need some plan for universal coverage. What should it be?
1. In a “buy-in plan” studied by the National Coalition on Healthcare (NCHC), the uninsured could buy into Medicaid, Medicare, or SCHIP (State Children’s Health Insurance Program). Individuals would pay on a sliding scale with government subsidies. NCHC believes that in the first ten years of such a plan, businesses now providing health insurance would save $848 billion and individual families who currently carry insurance would save $309 billion. But some people would be left out unless the “buying in” was mandatory.
2. A bill for universal health insurance has been introduced into the House of Representatives – The United States National Health Insurance Act. This plan is built on extending the present Medicare program to everyone living in the United States and the US Territories. It would be essentially a single-payer system.
3. We might consider a shared responsibility system like those that have been so successful in several other countries. The key component must be universality of health care coverage.
