A reader of The Lakeville Journal wrote in asking why a governmental health-care plan should cost anything, and whether access to the ER didn’t already constitute the provision of universal health care? Was he missing something?
My response was no, you’re not. In a way, you are understanding too well. But the bottom line is this: Whatever national health insurance scheme is eventually arrived at, it will “cost� far less than what we have now. With current health costs rising at 12 to 15 percent per annum, in just a few years the cost of the present system will dwarf any proposal now before Congress for universal health care for all Americans. Thus the cost of doing nothing is the highest cost of all.
Careful, objective, professional studies by the World Health Organization (WHO) show that the health outcomes of the major industrial, democratic and “socialist� countries which have national health insurance plans, far outperform the United States (measured in terms of life expectancy, infant mortality, control of conditions of disease, etc.), and they do so at far less than half the cost.
By “cost� is meant the total outlay by government, business and individuals, however distributed. Any way you slice it, the proof is that well-designed public plans deliver the best performance at lowest overall cost.
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At present we already have a partially government-run health system in the form of Medicare, Medicaid and the VHA. Recently on MSNTV a lady from California called in to express her opposition to “government-run� health care. The TV guy asked, what sort of health care she had now? She said she was on Medicare. He asked, was she satisfied? Yes, very; Medicare was covering her $4,000 a month prescription drug bill.
Is that not government health care? With this level of public understanding, one wonders how we can get anywhere with the American public. We spend much ink bemoaning the 45 million Americans who have no health insurance, but we tend to overlook the ones Michael Moore talked about in “Sicko,� the more than 200 million who do not have the insurance they think they have. When you really get sick, the private insurance coverage escapes by the back door.
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Yes, some sick people go to the hospital ER for treatment, and we subsidize their costs. The problem is two-fold. First, these people wait until they are truly sick before going, and then tie up ER facilities with everything from ordinary sore throats that could have been simply treated or prevented, to much more serious and potentially costly conditions that may require expensive hospitalization.
Second, only a relatively small percentage of the population actually gets treated in this way; most forego basic, primary care and prevention. Thus U.S. health care is not “universal� in fact. This is a leading reason why U.S. health-care performance trails the rest of the industrial, democratic, “socialist� world.
Barack Obama showed his hand on health care in his book on hope. His “plan� would be to sandwich what today we call a “public option� in a panoply of private and other plans in a complex U.S. health-care system. He based his plan, he said, on a study by the National Academy of Sciences, which my uncle Gerard Piel (of Scientific American) mailed to me in early 2000, partly because it drew on the actual, operational WHO plan that is working in over 200 countries, including the United States.
I have sent the Obama administration information about the WHO plan, because, when someone’s got a better mousetrap, why not copy it?
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The WHO plan is better even than the health coverage of the U.S. Congress, or of any known HMO or private health insurance plan. For example, in addition to the usual costs of doctors’ visits, prescription drugs, immunizations, hospitalization etc., it covers mental, dental, eyeglasses, prosthetics, etc. It covers those costs anywhere in the world; you can break a leg in the Himalayas, and you’re covered, regardless of provider. WHO has special mechanisms for controlling cost charges in different countries, and drug companies and other providers fear to fight these controls.
For lesser medical costs, the WHO plan covers 80 percent; patient liability is 20 percent. But when there are catastrophic costs due to heart, stroke cancer etc., the WHO plan switches to as high as 100-percent coverage and the patient liability to as low as 0 percent. (That’s the WHO answer to “Sicko.�)
The cost under the WHO plan? Under $300 a month for a family of four. In other words, an affordable, universal health insurance plan is feasible. The WHO plan resembles a standardized, single-payer system, so administrative costs are a fraction of what they are under U.S. private plans. The WHO plan is fully funded, so it is not dependent on future tax revenue, and no one can borrow from it to wage foreign wars. There are enormous savings in the WHO plan, and all income is plowed back into the fund.
That’s the secret of success. All we have to do is copy it. The unique cost problem for the United States, unlike WHO, is that in the United States we’re playing catch-up. We have to prime the pump for all those people who have never yet paid into the plan, but will have immediate health costs. We also have to fund, or help pay the premiums for, the truly poor and unemployed. That could cost a few billion dollars. If we can recover the economy, with full employment, the Obama plan will ultimately pay its own way. We can one day provide truly universal coverage to achieve “Health for All.�
But do we have the political will to do so? The HMO, insurance and pharmaceutical industries are spending multi-millions of dollars in the guise of supporting health-care reform, lobbying Congress to exclude a public option from the mix, on the grounds that (a) it would be inefficient, (b) yet it would out-compete private plans, and (c) anyway it’s “socialized medicine.�
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Congressional leaders like Connecticut’s own Chris Murphy are too savvy and have too much integrity to fall for these enticements. For example, Chris Murphy is working to close the “donut� hole in Part B pharmaceutical coverage of Medicare. He has fought and won cases of unacceptable insurance claim denial here in the Northwest Corner. He gives unremitting support to the Obama health reform bill, including retention of the public option — as a matter of free choice.
Whatever the exact form that the emerging plan takes, providing it retains the public option, it will outperform what we have now, it will cost far less than the cost of doing nothing, and it will help put the United States back in the running to compete in the worldwide economy.
Sharon resident Anthony Piel is a former director and legal counsel of the World Health Organization.
