I recently wrote a Health Care Policy Proposal paper in my Medical Sociology class (I'm an undergrad at UMass Amherst) and I'd thought some of you might enjoy it. As I said I'm only an undergrad so please don't judge it too harshly lol. Anyways, here it is....
Our health care system has turned into a disaster. There are few left who would dispute this claim, but the real question is: what are we going to do about it? There are two main schools of thought concerning how we should address the situation. There are those who believe that free market principles can save health care, and there are those who believe that we need to adopt a national insurance plan. I am in strong agreement with the latter of these two arguments as I believe only a single-payer health care system can guarantee the coverage of all Americans and finally reign in the escalating costs that plague our current structure. President-elect Obama has revealed a health care plan which is certainly a step in the right direction, but is not enough. In this paper I will list the major problems with our current system, describe why piecemeal solutions will not get the job done, illustrate how a single-payer system
will get the job done, and I will also explain why such a plan is politically viable.
In 2003, the United States spent $1.7 trillion on services related to health care (which comes out to $5,800 per person), and this accounted for 15% of the Gross Domestic Product (GDP). This is more than any other country in the world spends, yet our quality of care is nothing to brag about. If we continue on our current path then by 2013, we will be spending about $3.4 trillion a year on health care (Weiss 2008; 339). This means less money for other important things such as education, transportation, science, energy and many other essential services. Some of the things that have led to these high costs are; new high-technology procedures that are very expensive, yet often only have marginal benefits, increasing drug costs, and administrative overhead costs which account for over 20% of total health care expenditures (343). Since 2000 we’ve been spending about $200 billion a year on drugs alone (Angell 2005; 3). A more detailed description for the reasons of these high expenditures will be discussed later.
I would like to digress for a moment and explain how the high-technology procedures that were just mentioned are what drive a small amount Canadians to our country every year. These Canadians, however, are usually wealthy and their lives do not depend on such services, rather they are taking advantage of their wealth by enjoying the luxury health care services America has to offer. The reason I mention this is that there are some who will point to this fact to support their claim that Canadians think our health care system is better, and thus we shouldn’t waste our time pursuing a health care system like theirs, but this could not be further from the truth as most Canadians would laugh at such a suggestion. Later on I will explain why more common myths concerning single-payer systems are wrong.
High costs have left many Americans left out in the dust. At any given time roughly 50 million people are uninsured and this makes up 15% of the total population. (Relman 2007; 51). The dangers of not having health insurance are obvious enough, but if you’re still not convinced, 18,000 adults die each year due to a lack of coverage, not to mention many more who are alive but are living in pain (LeBow 2002; 17). The United States is the only Western industrialized country, regardless of how they raise funds, organize care, and determine eligibility, that fails to guarantee every citizen comprehensive coverage for all essential health care services (Quadagno 2005; 2). This embarrassing fact is something that we need to address immediately.
Unfortunately, not only do we have coverage and cost issues, but the quality of care is a problem as well. In our system, improving patient care has taken a back seat to economic interests. Insurance companies will often deny care to people who have conditions that will cost the company too much money. Imagine having a serious medical condition, like cancer, but not being able to find an insurance company that will help you pay for your medical bills. For those who are lucky enough to have insurance, many insurance plans only cover a limited amount of doctor and hospital visits. Also, our delivery system is so flawed that tens of thousands of Americans die each year due to hospital medical errors (Kohn 2000). Lastly, the 2000% growth of the number of administrators since 1970 has led to a tedious amount of paperwork, which is a headache for both patients and physicians (LeBow 2002; 56). Such developments have put primary care in a crisis as physicians are leaving the profession due to “poor compensation and plummeting job satisfaction” (Brewster 2008). This hurts patients too since they have to keep switching doctors, thus preventing them from developing a healthy relationship with their primary care-giver. In light of all these facts, it is no wonder a 2000 World Health Organization report ranked our health care system 37th overall in the world (LeBow 2002; 14).
There is good news, however, as President-elect Obama’s health care plan aims to address many of these issues. The following details of his plan were obtained from BarackObama.com. His first overall goal is to lower costs, and there are various ways in which he plans to do this. For example, he wants to invest $10 billion a year over next five years to bring electronic information technology to the health care system. This will supposedly save us $77 billion per year. Next, he promises to make prevention and disease management programs more accessible. For instance, he will require public plans, like the Federal Employee Health Benefit Program (FEHBP) and Medicare to utilize proven disease management programs. Then he intends to reform the market structure to increase competition and thus preventing “companies from abusing their monopoly power through unjustified price increases” (BarackObama.com). He says he will enact a new National Health Insurance Exchange that will help increase competition, allow consumers to buy drugs from other countries, prevent drug companies from blocking generic drugs from the market, and allow Medicare to negotiate for cheaper drug prices. Furthermore, he wants to reimburse employer health plans for a portion of “catastrophic costs”, provided that they guarantee their savings will go towards reducing worker’s premiums.
His second overall goal is to “ensure affordable, accessible coverage for everyone” and this is to be achieved through eight specific strategies. These strategies include; requiring insurance companies to cover pre-existing conditions, offering a public plan similar to what Members of Congress have, providing tax credits for families and small businesses, requiring large employers that don’t offer coverage to make contribution to new national plan, mandating that all children be covered and allowing children to keep their parent’s plan up to age 25, expanding eligibility of Medicaid and SCHIP programs, and lastly ordering that state plans meet the minimum standards of the new national plan. It is also important to note that he wants to expand funding for public health programs, and encourage new ones. This is essential, as I believe reforming the health care system is only part of the solution towards creating a healthier America.
As stated before, I believe this plan is only a step in the right direction as it does not address the underlying problem of our current system. The underlying problem to which I am referring, or the fundamental source of the all the ailments that are currently holding us down can be summed up in one word: profit. The commercialization of health care is what has brought the concept of profit to our current structure, and the only way to get rid of it is by addressing the privatization of health insurance. There are both ideological and pragmatic reasons why we need to end the commercialization of health care, and I will begin with the ideological reasons. I strongly believe that seeking to make a profit over the life-threatening conditions of others is unethical and unjust. How could we as a society allow modern medicine to transform from a healing profession into a business where the desire of profit takes precedence over greater human needs? When looked at in this context, the radicality of our health care system is revealed. It is my strong belief that every human being is endowed with the natural right to receive all the necessary health services that one’s society has to offer. Furthermore, I believe that it is our moral duty to provide such health services to those who do not possess the means of obtaining these services on their own. It is on these underlying principles that I base all my opinions expressed in this paper.
Even if you cannot be convinced ideologically that we need a national health plan, there are a number of pragmatic reasons for such a plan, and these reasons all have to do with the reduction of costs. First of all, health care institutions do not compete like other capitalist institutions by advertising prices, so there is no economic benefit to the public (Wells 2007; 2785). Arnold S. Relman, who is a well renowned physician and a long-time advocate of a single-payer system, pointed out that health care institutions and physicians are forced to compete for well-insured patients because it is hard to make a profit treating patients with no insurance or bad insurance. Non-profit institutions are forced to act like their for-profit counterparts by advertising expensive equipment and services to the well-insured, and therefore, non-profits act like profit maximizing institutions, and this is bad because costs inevitably increase (Relman 2007; 50). Also, the overhead administrative expenses of these institutions account for at least 20% of the total costs (LeBow 2002; 19). Relman points out how for-profit institutions contribute to this by “spending considerable money on high executive salaries and bonuses, consultants, legal advice, brokers, marketing and advertising, back office operations, public relations and lobbying, and many other expenses that are common in business…” (Relman 2007; 50)
Inequity is another consequence of commercialized health care as markets are not concerned with justice and equity, so private health care and insurance are sold by profit-driven forces, and those who cannot afford them are left behind. Those without insurance go to the emergency room (ER) when in need of care, and this has led to the falling apart of ERs across the nation due to the strain of too many patients (LeBow 2002; 16). President-elect Obama says he will offer a new public plan but he offers no concrete details and he will not mandate that all adults have health insurance, so under his plan there will still be some who remain uninsured.
The next major consequence has to do with the quality of insurance, as the commercialization of care puts profits over quality of care. Consumers cannot make informed decisions concerning what their needs are like in other markets. For example, well insured patients are often lured to fancy services and luxuries that have nothing to do with the quality of health care, and this increases overall costs. Also, insurance providers like HMOs, will regulate care by deciding what to pay for, and they will even discourage primary care physicians from the use of hospitals and expensive technology, as these serve as a roadblock in their quest to make a profit (Relman 2007; 64). In some instances, private HMO’s will reward their doctors with bonuses for denying care to patients with costly health conditions as documented in Michael Moore’s famous documentary, Sicko. Obama’s plan will help alleviate most of these symptoms, but will not eradicate them once and for all. I think a recent article from the Journal of the American Medical Association summed it up the best…“Perhaps it is time to wave the white flag and admit that it is impossible to develop policy initiatives that correct market distortions and produce a truly efficient health care market…” (Wells 2007; 2787). I thoroughly agree with this assessment and feel that it is time to adopt a much more feasible single-payer health system.
Based on all this evidence, it is clear we need to adopt a single-payer system, but what should this system look like? I want to note that I agree with Arnold Relman when he says that we not only need single-payer insurance, but also need to “reform the way physicians are organized in practice and how they are paid” (Relman 2007; 113). This will be explained in more detail later, but first I think the government needs to offer a single-payer insurance plan that will be relatively simplified in that it will eliminate the hassle, expense, and complexity of billing that is present in our current system. Private insurance companies will no longer be able to offer the services that will be provided under the public plan. This insurance plan will be funded by a health care tax levied by Congress, and these taxes should be based on income or assets. This plan will cover everyone, which means even people with no income or assets will still be included. Even if a person has pre-existing conditions which require expensive treatment, he or she will be included. We will not need any more money to reform the system; we will just be pooling all our current health care payments, and then using them to fund a more efficient system. All essential benefits will be guaranteed, including ambulatory and inpatient services, short-term and long-term care, drugs, psychiatric care, home care, and dental care. Unnecessary services, such as cosmetic surgery, will not be covered, and for people who want coverage for such unnecessary services, private insurance companies will be allowed to provide these, but only the services not provided by the national plan. Since everything will be pre-paid for, there will be no billing or payment transaction during trips to the medical facilities, which also means no more tedious paperwork for both physicians and patients, and no more ridiculous overhead administrative costs. As stated before, these administrative costs account for at least 20% of current expenditures. I do, however, think that money should be given to patients who have to use public transportation to get to the medical facility, like they do in some European countries. Also, there would be no more incentives for putting profits ahead of patient care. For example, I would suggest that physicians be offered bonuses for keeping the most patients healthy, as they do in England, opposed to receiving bonuses for denying treatment to costly patients, like in America.
As stated before, we also need a new way of delivering medical care. As Relman says “Physicians are better qualified than government, employers, insurance plans, or patients to assume this responsibility, but they must be organized in a way that allows them to use their best judgment, uninfluenced by financial incentives or constraints that prevent them from meeting their professional commitment to patients” (119). From this premise, he develops a smart idea which I agree with. He wants to create teams of approximately 50 to 100 physicians, half of whom would be primary care and the other half would be specialists. Every one group would be responsible for about 75,000 patients, or 1,500 patients per primary care doctor (who would be supported by nurse practitioners and physicians’ assistants) (120). They would be pre-paid and certified by a new national agency and most importantly, would be managed as a not-for-profit group. The physician groups (PGPs) would be given a percentage of the collective funds created through taxation. Any doctor who wanted to continue to practice solo would be allowed to do so, but would not be part of the national plan. Such physicians would find patients among the wealthy community, or anyone who was interested in additional non-essential services not covered by national plan. Medical facilities would also be not-for-profit and would negotiate prices with the PGP for their services, and I also agree with Relman’s recommendation that the “prices should be regulated and fully disclosed so there could be no special dealing between facilities and PGPs” (124). Lastly, the new system would have to be managed by a national agency that was accountable, yet independent, of Congress.
Another serious problem that plagues our current system is the high cost of drugs. As stated before, we currently spend about $200 billion dollars a year on drugs, but it does not have to be like this. If all Americans are under the same system, the payer suddenly has a great deal of power. For example, the VA gets a 40% discount on drugs due to its buying power, and this is also the main reason why other countries’ drug prices are so much lower than ours (PNHP). It is no wonder the drug industry is so opposed to a new national insurance plan.
We have to be ready for criticism and must be prepared to quickly correct any falsehoods that will be voiced concerning a new national health plan. Many of those who are still diluted by the idea that the free market can save health care will undoubtedly resort to scare tactics, such as throwing around the term “socialized medicine”. In response to such an attack, the real definition of socialism should be clarified, which is the state ownership of the means of production. Health care will still be privately administered, we will just all be under the same insurance plan, and that is not socialism, it is common sense. In matter of fact, the French health care system (which was rated best overall by the WHO and has a single-payer system) makes use of private insurance plans that pay patient’s expenses not covered by the national plan, and nearly 90% of the French population make use of such coverage. (Dutton 2007). Therefore, it can be said that a single-payer system is not socialized medicine, and there is still a role for private insurance.
It will also be suggested that under a new national plan, people will not be able to choose their doctor. This is simply wrong, as patients will be able to choose their physician as they do in Canada and many European countries. Patients can even seek treatment from doctors outside of the plan, as long as they do not expect the national plan to cover the costs. Long waiting times are another common criticism of single-payer systems, but the truth is urgent care is provided immediately, and there are only some waits for elective procedures, but nothing that is worth belaboring over (PNHP). There will also undoubtedly be people who say the new system will cost too much. First of all, businesses will save money, and as evidence, the three major automakers (General Motors, Ford, and Chrysler) have already endorsed a single-payer system (PNHP). Taxes will increase but there will be no more premiums, co-pays, deductibles, ridiculous drug prices, etc. France spends $3,500 per person every year on health care compared to the $6,100 the United States spends per person (Dutton 2007), and $3,500 is even considered expensive by single-payer standards, but it just goes to show how absurd our costs are. The truth is we cannot afford to
not adopt single-payer system.
Perhaps the most significant criticism of any proposed national health insurance has to do with its political viability. It is commonly believed that it would take a miracle for the United States to adopt a European-like health care system. Public opinion polls, however, tell a different story. First of all, a poll conducted last March revealed that 59% of all U.S. physicians support national health insurance (Fox 2008). This is huge as the health care reform efforts during the 90s ran into resistance from many physicians. Furthermore, an ABC News/Washington Post poll from last June reveals that 66% of Americans think it is more important to provide health care for all, even if this means higher taxes, whereas only 31% believed holding down taxes is more important, even if this means some Americans will be without care (PollingReport.com). Also, last September, a CBS News/New York Times Poll indicated that only 14% of U.S. adults think minor changes will be enough to fix health care (PollingReport.com) This shows that Americans are open to at least fundamental changes in the current system. But the most promising poll was a Yahoo News/Associated Press Poll from 2007 that revealed 54% of the nation supports a single-payer system (Yahoo News 2007). With the continued escalation of health care costs, I wouldn’t be surprised if this number is even higher now. Furthermore, we will soon have a Congress that is at least open to the idea of national health insurance.
To summarize, our current health care system has failed us considerably, and I believe only a single-payer system can adequately address its underlying problems. President-elect Obama’s health care plan is a step in the right direction, but is not a long-term solution. In all honesty, I think he understands this himself as he has hinted in the past an acknowledgement that we need a single-payer system. He is much smarter than I, and probably sees his current plan as a mechanism that will pave the way towards true national health insurance. And when we finally do achieve this goal, it will certainly not be a perfect system, as it will have its flaws, but as long as we have a structure that keeps costs under control and secures every citizen’s right to health care, we will at last have a system that is worthy of being called American.
Works Cited
Angell, Marcia. (2005). The Truth About the Drug Companies. New York: Random House.
BarackObama.com. (2008) “Barack Obama and Joe Biden's Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage for All.” Available at
http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf Accessed November 26, 2008.
Brewster, Annite. (2008) "The crisis of primary care physicians." Boston Globe.
http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2008/05/29the_crisis_of_primary_care_physicians/ Accessed November 26, 2008
Dutton, Paul V. (2007) “France’s model healthcare system.” The Boston Globe. 02 Dec 2008.
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/ Accessed December 02, 2008.
Kohn, Linda T., Janet M. Corrigan, and Molla S. Donaldson. (2000) To Err is Human. Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press.
Fox, Maggie. (2008). Ed. Will Dunham and Xavier Briand. Reuters. “Doctors support universal health care:survey.”
http://www.reuters.com/article/healthNews/idUSN3143203520080331?feedTye=RSS&feedName=healthNews&rpc=22&sp=true Accessed November 27, 2008.
LeBow, Robert H. (2002). Health Care Meltdown. Chambersburg: Alan C. Hood & Company.
Physicians for a National Health Program (PNHP). "Single-Payer Myths; Single-Payer Facts.”
http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php Accessed December 2, 2008.
PollingReport.com. “Health Policy”.
http://pollingreport.com/health3.htm Accessed November 20, 2008.
Quadagno, Jill. (2005). One Nation, Uninsured. New York: Oxford Press.
Relman, Arnold S. (2007). A Second Opinion: Rescuing America’s Health Care. New York: The Century Foundation.
Weiss, Gregory. (2009) “Uninsured in America.” The Sociology of Health and Illness: Critical Perspectives. 8th Edition. Ed. Peter Conrad. New York: Worth Publishers, 339-347.
Wells, David A., Joseph S. Ross, Allan S. Detsky. (2007). “What is Different About the Market for Health Care?” The Journal of the American Medical Association. 298, 23; 2785-2787.
Yahoo News. (2007).
http://news.yahoo.com/page/election-2008-political-pulse-voter-worries-highlights;_ylt=AkO9w4FTYhpdbrgapp1RIB9QzpB4 Accessed December 01, 2008
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