The Future of Health Care

What's the problem? - the cure?

Table of Contents:

• Executive Summary
• Status of health care in the U.S.
• How other Countries administer health care
• What Americans deserve
• Citizen actions
• Links to resources

Executive Summary

Managed health care, as administered in the U.S. by various private health maintenance organizations (HMOs), is malfunctioning and too costly. 45 million adults and children have no health insurance. Medicare is on the brink of bankruptcy, and Medicaid funding is on the block in President Bush's fiscal year 2006 budget. Locally the ranks of uninsured are growing. As reported on May 5, 2005, in the Erie Times-News, the percentage of adults living without health insurance is 15% in Erie County and 18% in Crawford and adjoining counties. This trend should be of immediate concern not only to the public at large and to our elected representatives, but also to health care providers. The average person in the United States is barely aware of what it is to have good medical care at reasonable cost. Until the public understands the magnitude of the problem, we can hope for nothing better. Senator Santorum is oblivious to the problem and has offered no solution. Access to basic health care is a fundamental human right. All U.S. residents deserve affordable, accessible medical care. Universal coverage can be provided with an apolitical National Health Program as outlined in this Position Paper.

Status of health care in the U.S.

The average person in the United States is barely aware of what it is to have good medical care. We currently, by-in-large are experiencing conveyer belt medicine and are indoctrinated by the media that Americans have the "best medical care in the world." In reality, we are dependent on medical care as dictated by the insurance industry (HMOs). About one-third of the health care dollar is not used for patient care, but for profits for the insurance industry, executive pay, stock holder dividends, payment of the company bureaucracy, payments to Washington lobbyists, and salaries for clerks in doctors' offices to do paper work. HMOs are run like a business, with patients providing revenue flow. According to a CEO of a large, predominately managed care hospital/clinic, "greed and self interest are the only incentives that matter in motivating physicians." (1) Because of high premiums charged by the HMO industry, 45 million Americans -- including more than eight million children -- cannot afford to be insured (www.covertheuninsuredweek.org). Medical expenses of both insured and uninsured account for over 50% of bankruptcies in our country. This occurs while, as reported by the AP on April 15, the United Health Group, an HMO, collected nearly $11 billion in premiums and had net income of more than three-quarters of a billion dollars in the first three months of 2005. The profits of such HMOs take away from funds that should be used to care for patients and to underwrite physician fees in areas of the country having shortages of physicians. Deterioration of the financial outlook for the Medicare Hospital Insurance (HI) Trust Fund that pays hospital benefits is much more severe and imminent than the projected fiscal problems of the Social Security system. Annual cash flow deficits beginning this year are expected to grow rapidly after 2010 as baby boomers begin to retire and will lead to exhaustion in HI trust fund reserves in 2019. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit that Congress enacted in 2004 will require substantial increases over time in both general revenue transfers and premium charges. See "The Burden of Social Security Taxes and the Burden of Excessive Health Care Costs," by Dean Baker and David Rosnick, March 24, 2005, http://www.cepr.net/publications/ss_hc_2005_03_24.pdf The real danger to Medicare's solvency is the privatization scheme built into the new prescription drug benefit. In order to qualify for Part D, seniors MUST enroll in a private Medicare HMO. These HMOs cherry-pick healthy seniors for enrollment, and dump ones having high medical expenses on Medicare. The results have been disastrous: Medicare is paying the HMOs up to 125% (average 108%) of what it would cost to treat the seniors in the traditional fee-for-service system. See here for more info. Most countries around the world take far better care of their people, achieve better results from their health care systems, and do it all at lower cost than in the United States. In 2001, per capita health care spending in the U.S. amounted to $4,887. That was 75% more than the $2,792 that Canada spends. Yet Canadians can expect to live 2.5 years longer then Americans. U.S. spending was 205% greater than Spain's, yet the Spanish can expect to live 2.1 years longer. The Japanese with a life span of 80.9 years, the worlds longest, can expect to live nearly four years longer than Americans, even though Japan's per capita spending on health care is only 41% of U.S. outlays. On this scale, the U.S. does not even rank in the top ten. But the statistics are even grimmer when life span is counted in years of healthy living. By this measure, the United States, in 2002, ranked a distant 29th among the countries of the world, between Slovenia and Portugal. (2)

How other Countries administer health care

Why does the rest of the Western World do so much better than America? They have national health services. Overhead costs in running the health program in Canada is only 2% for a fee-for-service Medicare program. Everyone is covered, and delays for treatment of acute conditions are virtually non-existent. Chronic conditions may take a bit longer than in the U.S. -- a total knee prosthesis in Ontario requires an eight week wait as opposed to three weeks in the U.S. Canadians get more doctor visits and procedures, more hospital days, and per capita, even more bone marrow, liver, and lung transplants than Americans. Canadian patients have an unrestricted choice of doctors and hospitals, and Canadian doctors have a wider choice of practice options than U.S. physicians. Surveys show high patient satisfaction in Canada. 96% prefer their system to ours, and 89% rate care good or excellent. (3) According to a World Health Organization study, the two developed countries ranked highest in providing health care to their citizens are France and Italy. Neither of them has a managed health care system. (2)

What Americans deserve

"A good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient." Francis Weld Peabody, M.D., Lecture to Harvard Medical Students. 1927. The best solution to the substantial problems of the present managed health care system in the U.S. is to replace it with a National Health Program. Full details of such a program, including financing, are available at the website of Physicians for a National Health Program: http://www.pnhp.org (or write Physicians for a National Heath Care Program, 29 E. Madison, Suite 602, Chicago, IL 60602). With a National Health Program, there would be universal coverage. No more 45 million uninsured, no more garage sales for the uninsureds' medical bills. There would be equity in hospital billing, regulation of gouging by the pharmaceutical industry, decent long-term care, and free access to physicians and collateral services. One should not confuse national health care with "socialized medicine." If politicians were involved, the situation would be no better than our current system as run by the insurance industry. According to the Physicians for a National Health Program's plan, the Program would be administered by an agency similar to the Federal Reserve Board, with managers appointed from among physicians, economists, industry, unions, and academic research. There would be government oversight to assure responsible management. We can have better health care by using available funds for patient care. In 1995, executives of the eight largest HMOs received between $2,800,000 and $15,500,000 in salaries. (1) Too much of the money we spend for pharmaceuticals ends up as campaign contributions to our senators and members of Congress.

What you can do about it

• Express your opinion in a letter-to-the-editor. Try to keep it under 250 words (to avoid editing), and be sure to include your full name, address and daytime phone number. Send to: Erie Times-News, 205 West 12th St., Erie, PA 16534, or fax: 870-1808, or e-mail: letters@timesnews.com
• Ask your member of Congress to co-sponsor H.R. 676, the United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act). This bill establishes the United States National Health Insurance to provide all U.S. residents with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services. It prohibits an institution from participating in the Program unless it is a public or nonprofit institution. Nonprofit HMOs that actually deliver care in their own facilities are allowed to participate in the Program. Patients will have the freedom to choose from participating physicians and institutions. H.R. 676 provides for appropriated sums to be paid for:
  1. by vastly reducing paperwork;
  2. by requiring a rational bulk procurement of medications;
  3. from existing sources of Government revenues for health care;
  4. by increasing personal income taxes on the top five percent income earners;
  5. by instituting a modest payroll tax; and
  6. by instituting a small tax on stock and bond transactions.

  Individuals whose jobs are eliminated due to reduced administration will be given first priority in retraining and job placement. The bill establishes a National Board of Universal Quality and Access to advise the Secretary and the Director to ensure quality, access, and affordability.

• Visit, write or call your member of Congress:
  • Honorable Arlen Specter SH-711, U.S. Senate, Washington DC 20510-3802 202/224-4254 (Fax) 202/228-1229 Suite 120B, Federal Bldg, 17 South Park Row, Erie 16501 814/453-3010 (Fax) 814/455-9925 (E-mail) arlen_specter@specter.senate.gov
  • Honorable Bob Casey SD-511, U.S. Senate, Washington DC 20510 202/224-6324 (Fax) 202/228-0604 . Erie Office: 17 South Park Row, Suite B-150, Erie, PA 16501 (814) 874-5080 (E-mail) go to http://casey.senate.gov/contact.cfm
  • Honorable Phil English (PA-3rd Leg. District) 1410 LHOB, U.S. House of Rep., Washington DC 20515-3803 202/225-5406 (Fax) 202/225-3103 208 East Bayfront Pkwy, Ste 102, Erie 16507-2405 814/456-2038 (local Fax) 814/454-0163 (E-mail) go to www.house.gov/english

  Toll free for Capitol switchboard: 1-800-247-2971

  • Honorable George W. Bush White House Washington DC 20500 202/456-1111 (Fax) 202/456-2461 (E-mail) President@whitehouse.gov

Endnotes

1. "Mismanaged Care: How Corporate Medicine Jeopardizes Your Health," Michael E. Makover M.D. Prometheus Books, 1998
2. "Critical Condition: How Health Care in America Became Big Business & Bad Medicine," Donald L. Barlett & James B. Steele, Doubleday, 2004.
3. Physicians For A National Health Care Program. http://www.pnhp.org.