The movie Sicko has stimulated discussion of health care costs and access in the United States. Our patchwork nonsystem of competing health care insurances, with its profit motive driving denial of care and of physician choice, is clearly failing. It needs to be replaced by a more rational and humane method of assuring universal coverage and care for all our citizens.
Despite spending more per capita on health care than any other nation in the world, we lag behind in infant mortality and life expectancy rates. It is disgraceful that the richest nation on the planet is the only industrialized nation that fails to provide health care to all its citizens. We have 47 million uninsured, and more millions partially insured, or insured for only part of the time.
More than half of all personal bankruptcies are precipitated by the enormous cost of serious illness, despite the fact that more than two-thirds of these unfortunate individuals actually had health insurance prior to becoming ill.
Most Americans believe that health care should be available to all, but that is far from the case. Many uninsured people defer or neglect health care, including cost-effective preventive care, for fear of incurring debt beyond their ability to repay. As a result, early illness may become incurable; yearly an estimated 18,000 uninsured Americans die needlessly in this country.
The best way to fix this unacceptable situation is to shift to a single-payer health care system. Overhead in the private health insurance sector is estimated to be nearly 33 percent. Medicare overhead is less than 3 percent. The $350 billion in savings that would occur by eliminating the profit motive and moving to a single-payer system, like Medicare for all, would allow us to insure our entire population.
Why is overhead so high in the private sector? Just think of all the clerical and administrative staff necessary to run the incredibly complex system of deductibles, co-pays, denials and determination of who is eligible for what coverage and when. And then there is the issue of multimillion-dollar salaries for the executive echelon in the industry. Is this the way our health care dollars should be spent?
Many are concerned about government involvement in health care financing; one hears supporters of the present arrangements solemnly pronounce fear of "socialized" medicine. In a single-payer system, they predict, care will be rationed and the government will dictate who gets care and how. This fear-mongering is simply untrue.
Further, we already have rationing of care (based on ability to pay), and interference in the delivery of health care, by insurance companies that limit care based on criteria that they establish and interpret.
What I, and the other 15,000 members of Physicians for a National Health Program propose is a centralized system of payment, not a system for the provision of care.
Under a single-payer system, physician choice would be maintained, and decisions made in the traditional fashion, between physicians and patients. The driving force would be patient welfare, not profit. Such a system would dramatically reduce physician paperwork and frustration as well, and might help stem the rising tide of physicians leaving practice.
Politicians justifiably fear being attacked by the health insurance industry on the topic of a single-payer health system. But this topic is so important to so many of us that fear of industry reprisal or attack must be swept aside, and a rational plan developed to phase out our present inhumane and costly patchwork for a single-payer system. This is the best way to assure access to health care for all our citizenry and improve our population's health. It is also the moral and right thing to do.
Jacobs is professor of medicine emeritus, University of Rochester, and vice chairman, Finger Lakes Chapter, Physicians for a National Health Program.
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