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Tax-Financed Health Care Offers More Value

by Johnathon S. Ross

Shame on all of us, especially those of us in positions of public trust. Forty-five million of our friends, family, and neighbors, including 1.3 million Ohioans, have no health-care coverage at all.

Tens of millions more are at risk of bankruptcy even though they have insurance. Their coverage is too skimpy to protect them financially.

What do the current conservative leaders of many states and the nation have to say about the fact that we spend twice as much as any other industrial democracy in the world and yet fail to cover 16 percent of the population? To paraphrase Marie Antoinette, "Let them buy high-deductible health plans."

But who are the uninsured? They are mainly (75 percent) lower-income working people and their kids. Most of these folks struggle to keep food on the table and the lights on. They can't afford even bare-bones policies.

What are the facts, not the hype, on market-based reforms such as Health Savings Accounts (HSAs), high-deductible health plans, and mandated insurance (a la Massachusetts)? These represent the next bogus effort to keep private insurers in charge of our crumbling sickness care non-system. Remember how they promised that a competing insurance market of Health Maintenance Organizations was going to save American health care?

Unfortunately, despite the nostrums of the market ideologues, health-care costs have continued to soar at twice the growth rate of the gross domestic product while 10 million more have gone uninsured. Pound as they might on the square peg of market forces, health care will never be a nice round market commodity.

Why? The consumer's not sovereign. The doctor, not the patient, orders the care. There's no easy exit from the market for patients. When critically (and expensively) ill, you buy or die. The most expensive health care is not necessarily desired. If open-heart surgery were on sale would you have two?

There's often inadequate information to make wise purchasing decisions. Sometimes the best doctors are unsure of the wisest course of action for a patient. It is the uncertainty of illness and its attendant costs that creates the need for insurance in the first place.

The profit motive runs contrary to the best cooperative and Samaritan traditions of medical practice and training. There are lots of natural monopolies. Should we build another hospital in Bowling Green so that the competition will leave them both half-empty? The market for medical services fails these tests of an effective market and will fail in the guise of health savings accounts.

The 10 percent of patients who are very ill generate 70 percent of the costs, averaging $39,000 per year. They will never save anything in their HSAs. Studies confirm that high out-of-pocket costs, the hallmark of HSAs, yield worse health outcomes for the poor, elderly, and chronically ill.

The health-care bureaucracy already consumes 31 percent of spending. The fees for tracking 300 million individual HSAs would only aggravate this shameful waste.

Half of personal bankruptcies are due to uncovered health-care bills, again the hallmark of HSAs. Even boosters of HSAs (Mckinsey and Co.) find 56 percent of employees less satisfied with their new accounts than their old health plans.

There is a national health insurance program (HR 676) in front of Congress and the Health Care for All Ohioans Act (HCFAO) in front of the Ohio General Assembly. Either of these plans would create an improved and expanded Medicare for all Ohioans.

Taxes would replace private insurance premiums and out of pocket payments. Taxes would go up but premiums and out of pocket payments would go down by even more. These funds, added to current public spending, would create a single insurance pool adequate to cover all for no more than we spend now.

How can this be? In a multi-payer system, the complexity yields high administrative costs. Each insurer, hospital, and doctor must keep track of myriad contracts, discount arrangements, benefit packages, formularies, limited referral networks, and insurance rules and regulations designed to reduce utilization and profit the insurers. HSAs leave this insurance and billing bureaucracy in place and then add the complexity of tracking millions of individual savings accounts.

Studies by the Government Accountability Office and the Congressional Budget Office both confirm this surprising fact - the administrative simplicity of a single universal insurance pool, such as Medicare, yields savings that allow comprehensive coverage for all at current levels of spending. A tax-based public system is simple and efficient. There is simply a lot less work to do.

How do we know it can be done? Because every other western industrial democracy already has a national health insurance program, each has managed to cover all their citizens at about half of what we spend and they still have better health outcomes than the U.S.

Business owners should realize that the health-care system provides the maintenance on their work force, just as other experts provide maintenance on their expensive and complex industrial and business machinery.

It makes good sense to get the most comprehensive maintenance system for the best price. More for the same money - value - is what tax-financed universal health insurance system can provide. Those businesses avoiding the cost of insuring their employees are the recipients of cost shifting. This occurs through higher taxes to fund indigent care and higher prices paid when doing business with companies who continue to insure their employees and pass along the costs shifted to them in the price of their products.

Patchwork solutions such as Medicaid expansions, vouchers, tax credits, or medical savings accounts won't work. They mainly serve to enrich the insurance bureaucracy. They fail to control costs and fail to cover everyone. Fundamental reform is what we need.

The Institute of Medicine estimates that 18,000 Americans die each year from lack of health insurance alone. A tax-financed universal health insurance system will save lives and save dollars. It's good for business and our health. Counter-intuitive or not, businessmen and all of us should support a single-payer universal health insurance solution. Financially, we already are.

What's the bottom line? America needs affordable universal health insurance. We can build it with administrative savings and public accountability but not with health savings accounts designed to profit Wall Street and the insurance industry. HR 676, the National Health Insurance Act or the Health Care for All Ohioans act would create an expanded and improved Medicare for all Ohioans. We know it would work because Medicare works. It would save lives and save money and it is the right thing to do.

Johnathon S. Ross MD, a Toledo internist, is past president of Physicians for a National Health Program (pnhp.org) and a member of the Ohio council of Single Payer Action Network (spanohio.org).

© 2007 The Toledo Blade

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