Perspective: Looking to the Future of Health Care in America
by Rick Bayer, M.D.
"How do we provide universal health coverage???"
care delivery in the United States is a disgrace. In 1998, 18%
of Americans under age 65 (44 million people) lacked health insurance.
The World Health Organization ranks the U.S. health system a dismal
37th in overall performance out of 191 countries. Equally dismaying
is the fact that we spend so much to get this dismal rating. The
U.S. spends more per capita on health care than any other industrialized
nation-$4270 per person in 1998, compared to about $2000 per person
among the 29 countries of the Organization for Economic Cooperation
of expense, uninsured persons often can't see a physician during
the early stages of an illness, and then require expensiveand
preventablehospitalization. Compared to insured adults,
the uninsured receive fewer screening services to detect early
cancer and heart disease, leading to an increased risk of early
care (or more accurately, "managed cost") contains obvious
conflicts of interest. The most troublesome is that health plan
managers take part in decision-making that should only occur between
patient and physician. Managed care creates financial incentives
that penalize primary care physicians for ordering diagnostic
tests and referrals to specialists. These incentives pit patients
against their primary physician and primary physicians against
specialist physicians. In employer-provided health insurance,
the employer is likely to choose a health policy with the lowest
premium to keep company overhead down, never mind the best interest
of the employee.
care should be a right, not a privilege. We should treat health
care just like educationwe provide public education to all
our citizens. All other industrialized nations provide universal
care to citizens at a much lower cost than our system.
do we provide universal health coverage? Recently, at an Oregon
Medical Association meeting, Oregon's Governor John Kitzhaber,
MD recommended expansion of Medicaid (Oregon Health Plan) to cover
people at up to 200% of the federal poverty level. American Medicare
and other single-payer systems used in Canada and Western Europe
prove the single-payer method of financing universal health care
is the most efficient and equitable solution. A publicly administered
single-payer system, such as Medicare, does not have profit as
its goal. Medicare consumes 3 percent of the dollar for administration
whereas managed care companies utilize 10 to 30 percent of each
health care dollar on marketing, paperwork, lobbying, excessive
executive pay and shareholder profits. Because the single-payer
method eliminates most administrative expenses, there should be
money available to cover uninsured Americans.
health care puts every citizen in the same insurance pool under
a single set of rules, which will drastically cut confusing rules
for physicians and for patients. Under a single-payer system,
administrators are able to use purchasing power with pharmaceutical
companies to lower the cost of drugs. In Canada, the cost of U.S.
manufactured drugs is approximately one-third less.
sometimes dismiss single-payer universal health care as socialized
medicine. But socialized medicine is a system in which the government
owns the facilities and employs the health care providers. In
sharp contrast, a single-payer system uses the existing private
and public health care delivery system and preserves private ownership.
Patients would retain choice of their physicians and hospitals.
are convinced that most Americans, and most physicians, support
health care reform based on precepts of social justice and medical
need, not the current reforms driven by Wall Street. If other
countries can provide universal health insurance for all citizens,
surely the wealthiest nation in the world can do likewise.
we must battle the greed of the pharmaceutical and insurance industries
that distorted and defeated the Clinton proposal in the early
90's and just spent over $5 million to defeat a Massachusetts
universal health care ballot initiative in Nov. 2000 (see www.pnhp.org).
"Health Care For All" is working on a single-payer program
for Oregon (www.healthcareforalloregon.org/).
result of our efforts will be a universal health care system "by
the people and for the people" that votersbanned from
the corporate boardroom-can influence through local, state and
Bayer, MD and Nancy Crumpacker, MD are both board certified
internal medicine physicians who are married and live together
in Portland, Oregon. Dr. Crumpacker specializes in medical oncology.
cover art © Leo Wyman
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