Health Care Reform: A Medical Emergency
Despite the economic recovery the number of uninsured continues to increase, and tens of millions who have coverage face increasing difficulties in affording care. Employers’ premiums are skyrocketing, workers are paying higher co-payments and deductibles, and seniors face soaring out-of-pocket costs. Meanwhile we perform hundreds of thousands of unnecessary operations and procedures, and often prescribe useless or harmful medications.
Recent health policies have encouraged an expanded role for investor-owned firms and private insurers. Several studies demonstrate that sick patients receive poor quality care in HMOs, and that satisfaction is worse in managed care than fee-for-service settings. Moreover, HMOs have actually increased Medicare costs. Meanwhile, HMO executives continue to receive obscene salaries; many health care firms have been implicated in massive fraud; for-profit hospitals and kidney dialysis centers have high death rates; and drug companies charge outrageous prices.
International experience proves that universal coverage is feasible and improves health. Every other developed nation assures health coverage for the entire population. Our infant mortality rate, among the lowest in the world in 1950, is now disturbingly high. We trail other nations on life expectancy, and score poorly on measures of premature death. Meanwhile, our health costs per capita are nearly double those of any other nation, and rising more rapidly. Indeed, GOVERNMENT spending on health care in the U.S. exceeds TOTAL health spending in any other nation.
Yet Americans have fewer physician visits and lower hospital use per capita than other nations. Surveys of English-speaking countries show that Americans face the greatest barriers to care.
National health insurance has effectively contained costs in Canada–perhaps too effectively. Canada's single payer system greatly simplifies administration, cutting insurance overhead to about 1% (vs. 15% of premiums in the U.S.) and reducing bureaucratic costs for hospitals and doctors. Overall, Canada saves about $1200 per capita annually on bureaucracy alone.
A national health insurance program similar to Canada’s could cover the uninsured and upgrade coverage for the millions who currently have only partial coverage, without increasing overall health spending. We already have in place the facilities and human resources needed to provide care to all Americans. Estimates from both government experts and private consultants confirm that bureaucratic savings would offset the costs of expanded coverage. Projections that national health insurance is affordable gain credibility because every other developed nation has universal coverage while spending far less than we do.
Americans pay a great deal for healthcare–funding princely incomes for executives and investors–but patients are denied care or forced to struggle to get what they need, and market values increasingly intrude in the examining room. Like people in other nations, Americans want a system that assures care when we need it at an affordable price, that engenders trust and respect, and affords patients choice. A universal, tax-funded, non-profit national health program organized like Canada's–though better funded–could achieve these goals.
Surveys have consistently shown wide popular support for national health insurance. Many physicians, including most medical school faculty and deans, now favor a single payer reform. Yet Congress and most state legislatures are swayed by the massive donations that come largely from the wealthiest Americans. As a result, policy debate is dominated by options that protect insurers and the drug industry rather than the health and wealth of the American people.
As the health crisis in our nation mounts, it is increasingly urgent that we implement national health insurance.
David U. Himmelstein, M.D.
Associate Professor of Medicine, Harvard Medical School, and Co-Founder of Physicians for a National Health Program
David U. Himmelstein, M.D., is an Associate Professor of Medicine at Harvard Medical School and practices primary care internal medicine and serves as Chief of the Division of Social and Community Medicine at Cambridge Hospital. He graduated from Columbia University’s College of Physicians and Surgeons, completed a medical residency at Highland Hospital in Oakland, California, and a fellowship in General Internal Medicine at Harvard. His research focuses on access to medical care, quality of care in for-profit settings, medical bankruptcy, the administrative costs of medical care, and the feasibility of national health insurance. He has authored or co-authored more than 100 journal articles and three books. He co-founded Physicians for a National Health Program.