The solution to the problems I outlined in Part I that confront Americans regarding our medical care system is simple and proven. We need Universal National Health Insurance that is:
(1) Universal – all Americans would be fully and uniformly covered; no tiers for “commoners”, the elite, and the uninsured.
(2) Portable – coverage stays the same regardless of changes in employment, residence, age or marital status.
(3) Accessible – medical services would be covered from any provider anywhere…no “preferred” providers.
(4) Comprehensive – no denial of care for “pre-existing” conditions, no “pre-approval” of treatment, no exclusions, no cut-off ceilings.
(5) Publicly administered – Oversight of effectiveness would be provided by public scrutiny, the democratic process and medical professional review, rather than by corporate CEOs, accountants and their desire to maximize profits, dominate the market and rake in millions in bonuses, stock options, and golden parachutes.
And we need, we must have, medical care providers that can retain the commitment and the ability to serve, first and foremost, the traditions and ethical standards of their ancient and honorable profession.
The free-wheeling insurance and HMO giants have transformed U.S. health care because their arm-twisting drives providers (the traditional private practice physicians and the independent community based hospitals directed largely by practicing doctors) into takeovers by for-profit corporations and mergers into mega-corporations which then wrestle with the insurance companies for slices of the billions of health care dollars. The more health care dollars there are, the bigger the pie. The fewer of those dollars actually spent on health care, the bigger the profit margins. The consequences to us of this development in health care are severe, and adverse to cost containment, quality of care, and choice in America.
All modern industrialized nations in the world…except the U.S.…have Universal National Health Care. And U.S spending on health care per person is twice that of all other modern industrialized nations. Switzerland, our nearest competitor in big spending, puts out 65 cents for every dollar we spend per capita. At the time that Universal National Health Care was first mandated in Canada, their costs were the same as costs in the U.S. But by 1995, Canada’s total health expenditures per person were only 55% of what America was spending. These countries health care costs are way less than ours because their systems are publicly funded, universal and comprehensive. There are no legions of what we used to call paper shufflers, no determining eligibility, no chasing after payments from impoverished patients, no prior approval for medical treatment, no endless variety of complicated forms and procedures depending on which HMO or insurer, which species and permutation of health care “Plan” applies. Doctors and nurses can spend all their time on patient care, much less of their time on paperwork and none being monitored or struggling to understand and comply with payment and treatment directives from a myriad of insurers. Canadian hospitals spend 30% less on administrative costs than do U.S. hospitals.
The American employment-based multiple-private-insurer system, full of dangerous gaps and loopholes, leaves American business holding the bag. A small business with few employees has no leverage negotiating with the insurers. To provide employees with truly good (check the fine print) coverage places the business at a severe disadvantage with the competitor who slyly provides junk insurance or none at all. Associations and big corporations are also caught in the crunch. Fifteen years ago, Chrysler spent $500 more to build a car in Detroit than it did to build one across the bridge in Ontario because of the cost difference of health care. That’s another excuse for jobs to migrate overseas. And it’s only gotten worse. Canada spends 10% of GDP on health care costs while the U.S. spends 14%.
Quality of care is secondary to the profit motive in the U.S. system. All countries ration medical care. In Canada this rationing depends on urgency of medical need. In the U.S. it depends on (a) whether your particular insurance coverage even allows you to get in a particular service line, and (b) whether you can pay to jump to the head of the line. Managed care attempts to control costs by monitoring and controlling the treatment plans of physicians. But under Canada’s national universal plan, doctor’s clinical decisions are neither questioned nor monitored except by the College of Physicians and Surgeons. In Canada there are 25% more nurses working per capita than in the U.S. where providers rely heavily on untrained “aides” and “assistants” for patient care. After WWII the U.S. led the world in life expectancy. By 1997 American women ranked 20th among industrialized nations, American men ranked 22nd in life expectancy, and the U.S. ranked 24th in infant mortality. The thirteen page Canada Health Act enacted unanimously in 1984 also covers nursing home, home care, residential care, and ambulatory care as needed. Canadian elders receive four times as many home or nursing home care-giver visits as do American elders. Quality of medical care in a nation is not measured by what is procurable by the very wealthiest of individuals. It is measured by what is actually provided to all of the people.
Paradoxically, citizens in countries that have publicly financed Universal National Health Insurance have much more individual choice in their medical care than do we Americans with our privatized, for-profit, multiple-insurers, employer-based system. Most people in the U.S. have a “choice” of only one “Plan”, that chosen by their employer. Preferred provider lists and required pre-approval restrict us to specialists, hospitals and treatment plans chosen neither by us nor by our doctor. If the HMO takes a hike, if our job changes or if the boss decides to sign a different contract, we may have to change our family doctor and get a whole new preferred provider list. Universal National Health Insurance lets you chose any doctor you want; the doctor and patient can refer to any specialist or hospital; and there is no pre-approval required of your doctors treatment plan.
A Gallup poll found that 96% of Canadians prefer their health care system to the U.S. model. Despite all the misinformation here, a majority of Americans also prefer Universal National Health Care. And regarding trust; a 1997 public poll published in the New England Journal of Medicine found that “health insurers and managed care companies were ranked 2nd & 3rd from the bottom, just above the tobacco industry”. Let’s get the health care system we need, now, and stop the corporations, with their obscene campaign “contributions”, that are getting rich off the present mess by derailing real reform.