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The U.S. Health-Care Blues
Published on Sunday, April 22, 2001 in the Boulder Daily Camera
The U.S. Health-Care Blues
by Frederick C. Sage
It's no secret that our health care system is in trouble: hospitals running in the red, doctors getting fed up and retiring early, nursing school applications down 25 percent from 10 years ago, 44 million people without health insurance, the uninsured clogging emergency rooms, financial disaster hanging over all but the rich; medical bills are now the second leading cause of personal bankruptcy.

To discuss the matter, some historical background is necessary. One hundred years ago the leading causes of death were infection, accident and childbirth. Quick and cheap. Now the leading causes of death are heart trouble, cancer and stroke. Slow and expensive. Sixty years ago, when you were old, you were either healthy or dead. An illness or injury that is now expensively disabling was usually fatal. This was the case back to the beginnings of humanity. We now have a new ballgame with major implications that have not been well recognized.

The non-profit Blue Cross (hospitals) and Blue Shield (doctors) were the first wide-spread health insurance plans, beginning in the late 1920s. They were the only game in town, generally, until the 1950s. They paid out 94 percent of the premiums in benefits compared to the for-profit companies today who get upset if they pay out 80 percent. Incidentally, the hospitals' administrative overhead has gone from 8-10 percent of cost to 20-plus percent, largely due to the problems with the myriad insurance plans. Interestingly, the American Medical Association opposed health insurance until after World War II. The for-profit companies had experience with the war plants covering a young, healthy population while the Blues covered nearly anyone.

The for-profits saw that they could, by careful selection — cream-skimming if you will — undercut the Blues, even adding to the group plans very profitable life and disability insurance to cover below-cost health insurance. They soon grew into the big chain operations, buying up struggling hospitals, signing up physicians who were afraid of "government medicine" and going after the big bucks.

OK, so what about universal coverage? First of all, by eliminating the big administrative overhead, the uninsured can be covered for no additional money. These people usually do get care eventually for major problems; many of the problems become major because of lack of early attention. It would relieve businesses of the big expense and hassle of insuring employees. There is no logic in tying health care to employment. In addition, physicians could practice medicine rather than wrestle with the swarm of insurance companies.

All other industrialized countries have some form of universal coverage. Our neighbor Canada's system began soon after WWII in Saskatchewan. Our countries are different but we can learn a lot from their experience. The 10 Canadian provinces run their own programs with some federal money. They operate under five principles: the program must be universal, comprehensive, portable, accessible and publicly administered. People have free choice of provider. A province has a lot of bargaining power with drug companies and others. In the three territories the plans are all federal. Canada spends 9 to 10 percent of its gross domestic product on health care while we spend 14 to 15 percent.

A major problem Canada is having now is underpayment by the provincial and federal governments. The same thing is happening here on the part of Medicare, Medicaid and private plans in the U.S. Waits for non-urgent problems tend to be longer in Canada than here, where, if you have the money, you can get service in a reasonable time and if you don't have the money, you're out of luck.

There are heavy propaganda campaigns in both our countries against universal health insurance. One public relations and lobbying company was paid $80 million to fight Hillary Clinton's scheme which, admittedly, was far too complex but, ironically, tried to include the private companies. Don't believe everything you hear. Canada has had 50 years of experience and the public is sold on it, — especially when they become familiar with our system.

This is not intended to suggest any details of universal insurance system, but only to recommend action toward that goal.

For further information on Canada, there is an excellent article by Daniel Krater in the New Rules Journal at Another good summary of the Canadian system can be found at, or just root around in Canada/health on the web.

We may have the best health care in the world — IF you have the money, live in the right place, are medically sophisticated and have a profitable illness. However, we are ranked 37th in the quality of our overall system by a World Health Organization study.

Frederick C. Sage has lived in Boulder for 26 years.He has a master's degree in hospital administration from the Columbia University School of Public Health and is now retired after a 40-year career in health administration.

Copyright 2001 The Daily Camera


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