U.S. Health Care--Killing the Comeback

Rob Widdis / European Pressphoto Agency

At General Motors, sales are slumping, debt is in the junk range and the stock is so low it could fall out of the Dow. As has been pointed out for the last two decades much of that lost competitiveness lies in the spiraling cost of employee health care.

The United States is the only industrialized nation that does not guarantee access to health care as a right of citizenship. 28 industrialized nations have single payer universal health care systems, while 1 (Germany) has a multipayer universal health care system like President Clinton proposed for the United States.

Here are some of the myths that opponents to a national health insurance are still propounding:

The United States has the best health care system in the world.
Wrong--The United States ranks poorly relative to other industrialized nations in health care despite having the best trained health care providers and the best medical infrastructure of any industrialized nation.

Americans with two or more chronic conditions, for example, are twice as likely to experience medical, medication, or lab errors as people in countries such as Germany. Additionally, they are 38 percent more likely to receive conflicting information from different health care providers than people in Canada.

We also have longer waiting times for needed care than people in countries with so-called socialized medicine. Only 30 percent of Americans have access to same-day care. In Germany, 55 percent do. In New Zealand, 53 percent do. Americans find it twice as difficult to get care at night and on weekends without going to emergency rooms compared with the Dutch.

And (not surprisingly in the most expensive health system in the world), the cost of health care in the United States poses health risks. More than 30 percent of adults in the United States report some cost-related barrier to needed care. If the person has a chronic disease, the percentage increases to 42 percent. This is nearly five times higher than in the United Kingdom.

In fact, the United States continues to slip in international rankings of life expectancy, as other countries improve their health care, nutrition and lifestyles.
Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.

"Something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries," said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

What about the idea that our system here in the United States allow for the latest technologies to be accessed by encouraging wider innovation?
Wrong--While that may have held true in the past costs are already reaching their tipping point:

The Effects of HMO and Its For-Profit Expansion on the Survival of Specialized Hospital Services

Yu-Chu Shen
U.S. Naval Postgraduate School - Graduate School of Business and Public Policy; National Bureau of Economic Research (NBER)

July 2006
NBER Working Paper No. W12374

Abstract:
This study examines the effect of HMO and for-profit HMO share on the survival of safety net services and profitable services in hospitals. Using data from 1990-2003 and proportional hazard models, I find that hospitals in high HMO markets started out having lower hazard of shutting down services in 1990-1994 than those in low HMO markets, but their hazard rates increase over time. By 2000-2003, hospitals in high HMO markets ended up with higher risk of shutting down profitable services than those in low HMO markets. Conditional on overall HMO penetration, markets with higher for-profit share of HMOs have higher hazard of shutting down services, and the gap in survival between high and low for-profit HMO markets is bigger in high HMO areas. Lastly, I find that the hazard rate of shutting down profitable services is comparable among not-for-profit, for-profit, and government hospitals, while the hazard of shutting down safety net services is the highest in for-profit hospitals and lowest in government hospitals.

So while the costs continue to rise, making health care an unmanageable burden on families and businesses alike, our health-care providers struggle to reach their sickest patients.

Executive Summary: Physicians for National Health

"We endorse a fundamental change in America’s health care - the creation of a comprehensive National Health Insurance (NHI) Program. Such a program - which in essence would be an expanded and improved version of Medicare - would cover every American for all necessary medical care. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Investor-owned facilities would be converted to not-for-profit status, and their former owners compensated for past investments. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules - often rules designed to avoid payment."

The fact is, since our health care system is designed for producing expanding profit the outcome is predictably undemocratic:
Hospitals and doctors criticize Florida's HMOs for not passing along any of their higher profits to health care providers.

[health plans have sought more control through pay-for-performance arrangements, which reward doctors for seeing healthy patients and penalize them for taking on sicker patients who will have worse outcomes, says Broward County Medical Association President-elect Dr. Tony Prieto, a family physician in Plantation. "We don't practice medicine anymore," he says. "We practice what insurance companies want us to practice."

On an individual HMO level, Humana Medical Plan Inc. and its CarePlus Health Plans Inc. subsidiary earned $192.9 million on $4.4 billion in revenue in Florida -- topping all HMOs in both measures.

Meanwhile, AvMed Inc., a nonprofit HMO from Miami and Gainesville, is riding high after growing its income 70 percent -- to $56.5 million -- in 2007. It also increased its revenue to $960.2 million and its membership to 215,804. AvMed reduced expenses through programs to contain medical and operational costs, says spokeswoman Conchita Ruiz-Topinka. It also will raise its premium rates by 8-12 percent this year]

We are about to hear a lot of hoopla about mandated coverage and socialized medicine. Just remember the next time some two-faced politician starts blathering about "our great country" that for lack of money and adequate coverage a 12-year-old American boy died at great cost, from an untreated toothache.