The time has arrived for universal health care in the United States. This is no longer a debatable issue. But the mechanism for providing universal care, and particularly for providing it affordably, is contentious in the extreme. Mountain State Physicians for a National Health Program feel strongly that our current system of employment-based, for-profit health insurance is no longer serving us, and the state and nation can afford health care for everyone only through a single-payer health plan.
Consider these issues:
- More than 47 million Americans are uninsured now and the number is steadily increasing.
- Tens of millions more are underinsured.
- More than half of personal bankruptcies are related to medical expenses for the underinsured as well as the uninsured.
Our current approach to containing costs is based on the unproven assumption that people spend their health care dollars frivolously. Increasing costs such as increasing premiums, co-pays and deductibles as well as self pay are said to make individuals more “responsible.” Health savings accounts are proposed. The result is that the affluent do well. The relatively indigent suffer. They must decrease all medical expenses, essential as well as “optional.”
- For those actually able to pay their bills, the uninsured always pay more for the same care than anyone else, sometimes more than twice as much as the insurance company bargain price.
- Multiple parameters confirm that the uninsured and underinsured receive poorer services and have poorer outcomes.
- 18,000 deaths per year are attributed to lack of care secondary to lack of medical insurance.
The United States pays more per capita for health care, almost twice as much as the second highest spender, than any other developed nation. All other first world countries provide universal (for all citizens) health care at approximately half our per capita cost or less.
The federal government, together with state governments, already pay an estimated 60 percent of total health care costs, more than any other country pays in toto; demonstrably, given the right organizational approach, there is money enough to cover health care for all U.S. residents.
Businesses in the United States largely finance our private health insurance system, and many are being pinched by rising health care costs. Their competitive edge is definitely being impacted as compared with foreign companies that do not carry the health care burden.
In spite of paying more per capita, the United States is behind on many significant parameters of wellness, including: life expectancy, infant mortality, availability of primary care including immunizations, hospital staffing, hospital beds per capita, doctor visits per patient per year, availability of high tech equipment such as MRI machines, or care of the chronically ill to name some.
Current insurance reimbursement schedules shortchange primary care physicians. For more than 10 years the number of primary care physicians has been steadily decreasing, impacting continuity of care and availability of preventive medicine. Physicians are choosing more lucrative specialties and subspecialties.
All doctors would benefit from single-payer health care. Individual and group providers carry much uncompensated care on their books, and their administrative overhead is huge, for pre-approving, re-submitting, appealing, billing and collecting from insurance companies and self pays. Additionally, US doctors face more intrusive cost reviews.
The same can be said for hospitals. Staffing is problematic because the system necessitates a major increase in administrators while medical personnel decrease. Also, the profit motive directs hospitals into lucrative areas of medical care instead of into providing community-oriented services.
Other social investment is shortchanged as health care costs increase. Funds devoted to health care cannot be spent on infrastructure, education, safety services, libraries or any other social good.
There are many variations on the universal paradigm, but all revolve around government responsibility for comprehensive, universal care that limits the role of profit in the distribution of care. All involve emphasis on preventive and primary care. Most depend on independently practicing physicians.
Our current medical care non-system is a hit-or-miss travesty that nowhere intentionally comports with the public good.
Single payer will not solve all problems of medical care availability and cost control, but it is the only system that allows – in fact, requires – society to make decisions regarding needs, priorities, budgeting and distribution, which will allow for a more useful, efficient and equitable approach to cost control while providing care to everyone.
If the whole public is served by the same system, the whole public will have a vested interest in participating in its construction, and, as time, technology and experience require, its renovation. A 'we’re all in it together,' win-win approach is the ideal way to find a whole workable solution for any issue that impacts all of society.
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