a couple of tidbits...
The most credible estimate of the number of people in the United States who have died because of lack of medical care was provided by a study carried out by Professors David Himmelstein and Steffie Woolhandler (New England Journal of Medicine 336, no. 11 <1997>). They concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDs. It is important to note here that while the media express concern about AIDs, they remain almost silent on the topic of deaths due to lack of medical care. Any decent person should be outraged by this situation. How can we call the United States a civilized nation when it denies the basic human right of access to medical care in time of need? No other major capitalist country faces such a horrendous situation.
But the problem does not end here, with the uninsured. An even larger problem is the underinsured, that is, people whose health benefits coverage is inadequate. Most people find, at a crucial moment in their lives when they really need care, that their health insurance coverage does not include the type of medical problem they have, the type of intervention they need, or the type of tests or pharmaceuticals they require—or, that it covers only a minute portion of what must be paid for the services. We, as Americans, are the citizens with the least amount of health benefits coverage in the western world. Even the federal programs, such as Medicare (which in theory should cover all care for the elderly), are very insufficient.
On Rationing...
Won’t this result in rationing like in Canada?
The U.S. already rations care. Rationing in U.S. health care is based on income: if you can afford care, you get it; if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. Many more skip treatments that their insurance company refuses to cover. That’s rationing. Other countries do not ration in this way.
If there is this much rationing, why don’t we hear about it? And if other countries ration less, why do we hear about them? The answer is that their systems are publicly accountable, and ours is not. Problems with their health care systems are aired in public; ours are not. For example, in Canada, when waits for care emerged in the 1990s, Parliament hotly debated the causes and solutions. Most provinces have also established formal reporting systems on waiting lists, with wait times for each hospital posted on the Internet. This public attention has led to recent falls in waits there.
In U.S. health care, no one is ultimately accountable for how the system works. No one takes full responsibility. Rationing in our system is carried out covertly through financial pressure, forcing millions of individuals to forego care or to be shunted away by caregivers from services they can’t pay for.
The rationing that takes place in U.S. health care is unnecessary. A number of studies (notably a General Accounting Office report in 1991 and a Congressional Budget Office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are at 31% of U.S. health spending, far higher than in other countries’ systems. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing.