I’m told lists interest readers, so this is my list of objections to a national health insurance scheme.
1. We don’t need it, our health care is the best in the world: (medicynical note: those who actually believe this are the same ones who still believe there are weapons of mass destruction in Iraq, that Iraq was involved in 9/11 and that we are bringing democracy to the Middle East ) Facts suggest otherwise. America has the second-worst newborn death rate among the world’s 44 most highly developed countries, according to researchers with the Save the Children foundation.
“Despite spending over $2 trillion a year on health care — 18% of the U.S. GDP and twice as much as any other nation — the United States ranks only 45th in life expectancy and 37th in a World Health Organization study on the performance of national health systems. The U.S. federal government currently spends more on health care than on Social Security and national defense combined, the next most expensive items, but Americans get the right treatment only 55% of the time. Expenditures on health care in the United States — already the highest per person in the world — are predicted to nearly double by 2016, to $4.1 trillion, or 20% of GDP. That means, if this trajectory is not altered, in less than a decade, 20 cents out of every dollar produced in America will be spent on health care. Currently, more than 75% of health care dollars are spent on patients with chronic diseases, yet an estimated 80% of all chronic diseases are caused by preventable factors, such as smoking, obesity, and physical inactivity. But despite these statistics, less than 5 cents of every health care dollar is spent on prevention and public health.” (medicynical emphasis)
2. Will Stifle creativity: This is an overblown fear based on the notion that if private enterprise makes less money, there will be fewer medical advances. This is clearly not case for all the other countries in the world yet we persist in this delusion.
In fact in the past thirty years the research establishment changed. We’ve gone from salaried researchers with modest financial aspirations to entrepreneurial researchers co-opted by the health industrial complex. Medical advances are quickly patented and taken private. Government sponsored research that you and I paid for is transformed into the private property of international corporations and sold back to us a with huge mark-ups. “The Free Market” is subverted by generation long patent protection which essentially creates a government sanctioned monopoly.
This change has paralleled, or if you will stimulated, an unprecedented inflation in health care costs. We’ve gone from medications costing tens of dollars/month in the 70’s to hundreds in the 80’s, thousands in the 90’s and now tens of thousands of dollars/month for medications. This is unsustainable.
Yet, as recently as 30 years ago the great majority of research was done in university labs that were unaffiliated with big PHARMA. Medical progress was accomplished without obscene profits and confiscatory (from a medicynical point of view, predatory) pricing–the yearly costs for some drugs alone now exceed the cost of automobiles and over a lifetime, homes. What changed were laws that allowed the patenting and commercialization of government funded research. The continued creativity in medical research has been fueled by greed and in this case greed is definitely not good. There are regulations in the patent laws of the 80’s that require reasonable pricing but that provision has never been enforced. If we simply not allow patenting of government funded research and/or require reasonable pricing of advances creativity will find other ways of happening.
Another argument in favor of controlling drug costs is that science has a rhythm and advances occur when the basic science has matured. At that point progress becomes inevitable and will occur whether drug companies are making huge profits or more reasonable modest incomes. As a matter of fact a case can be made that the profit motivation distorts the medical system and that our lack of quality and accessibility is directly related to the excessive costs driven by our private system.
3. Will cost too much: This argument is so specious that it’s almost humorous. We already pay thousands of dollars more each year/capita than the rest of the industrialized world for health care.
We need to develop a culture of efficiency in health care and cut administrative costs which now total 30% of expenditures. This is far in excess of other countries where such costs are often less than half ours.
Right now there is no reason for anyone to control costs. With the exception of physicians and some hospital fees, which have been continually under attack by insurers, we pay whatever the supplier demands. Interestingly the insurer’s interest seems not to lessen the cost to consumers, but rather to maintain their own profits–as indicated by bonuses and investors concern with profit margins. The lack of a culture of efficiency is highlighted by the Bush administration’s opposition to Medicare negotiating price of drugs with pharmaceutical companies. Quite amazingly they’d rather have a multitude of private companies each with a 20-30% administrative overhead and little leverage do the negotiating. This is a revealing policy, but not a surprise, given the campaign contributions of PHARMA to various politicians–both Democratic and Republican.
4. Will result in rationing and waiting lines for care: We already have economic rationing of care. Many cannot afford treatments whether they have insurance or not. Furthermore, we have 43-47 million people out of the system.
In regard to waiting times the chief medical officer of Aetna, Troy Brennan, noted in a March 2007 Business (unable to find the actual Business Week article but these are the quotes):
“Waiting times in the United States are as bad as or worse than Canada. And, unlike the United States, in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, pre-existing conditions or because it wasn’t pre-approved.”
“The U.S. “health care system is not timely.”
“Recent statistics from the Institution of Healthcare Improvement document “that people are waiting an average of about 70 days to see a provider.”
“In many circumstances, people initially diagnosed with cancer are waiting over a month, which is intolerable.”
5. Private Insurance Industry Assures quality of care and competition: This article about a patient with pancreatic cancer highlights the conflicts of interest of private health insurers. They are in business to make a profit and will limit patient’s care sometimes to the great detriment of the patient.
In fact, Medicare was created in the sixties because private insurers wanted no part in insuring the high risk elderly. Private insurance companies work hard to segregate risk and limit their coverage to low risk, healthy individuals. Saying it another way, health insurers want to recruit the healthy and eliminate those with illness from their rolls–they think of them as cost center. In our employer based health insurance system the insurance industry has a near perfect system of flushing those with serious illness from their rolls. The system works like this. An employee becomes ill, can’t work any longer and thus loses the employer provided insurance coverage. (18 months of Cobra coverage is possible) As the illness continues the patient either has to use his/her resources to buy an expensive individual policy–made more so by the presence of illness. Alternatively the patient is moved to government insurance, i.e. Medicaid or Medicare. If a family member is involved the situation is more difficult for the insurer as the employee will continue working. But the employee loses the possibility of job change as future insurers have waiting periods and indeed new employers may be reluctant to take on a family with chronic continuing illness.
It should be obvious from the above that insurers have conflicts of interest. It is in their financial interest to limit claims and improve company profits–that is after all the fiduciary responsibility of the company’s management. Sometimes the insurer can be helpful and work with and monitor practitioners on the patient’s behalf. But at times the insurer’s financial interest influence decisions and not work for the benefit of the patient.
For private insurance to work in health care it needs to be non-profit and understand that it’s job is to assume risk and provide funding for care in the most efficient manner possible. That means cutting administrative costs, now about 30% of expenditures (as noted above other countries pay 1/2 or less of this amount) and having a large enough population of high and low risk patients to spread the cost. Afterall that what insurance is supposed to do.
6. Will encourage terrorism: Someone actually said this:
“National Review Online columnist Jerry Bowyer attacked Michael Moore’s movie SICKO and its positive portrayal of the health care in countries such as Britain and France. He argued that national health care systems are breeding grounds for terrorists because they are “bureaucratic.” “I think the terrorists have shown over and over again…they’re very good at gaming the system with bureaucracies,” said Bowyer.”
(Medicynical view: Bowyer did not address the other possibility that our current health care non-system with it’s multiple bureaucracies, monetized medicine, arcane unpublished rules stacked against the consumer is the cause of terrorism–as in Denzel Washington’s John Q?)
7. The marketplace is the solution to the health care problem: This from the Future of Freedom Foundation summarizes this solution:
“So the only question is, what system has shown itself capable of best distributing the greatest amount of any good or service to the greatest number of people, at the highest quality and lowest price? The answer is the free market. Medical care is no different from any other commodity. In order to be most efficiently and widely distributed, it requires the unfettered signals of supply and demand, lest it fall victim to socialism’s standard shortcomings: bureaucratization, rationing, rising costs, overproduction (in some areas), underproduction (in others), and eventual failure.”
The first problem with this analysis is that health care is NOT like any other commodity that people can take or leave as they wish. It is often needed in emergent situations where shopping is not at all possible and the consumer simply must take whatever is available at the demanded cost. Because an illness may involve the actual life and death of a person his/her decisions reflect anxiety, financial status and the person’s understanding of the situation. This last factor should not be underestimated with patients in the majority of instances not fully understanding the risks and/or benefits of treatments and the alternatives. The patient is thus greatly influenced by physicians, manufacturers, insurers, etc. all with superior knowledge of the situation and financial conflicts of interest that interfere with unbiased advice.
The result is that our limited “free market” system in health care fails. To create the Future of Freedom’s ideal system here would require the dismantling of such distortions as Medicare, Medicaid, the entire patent system, the FDA (which monitors drugs and medical devices for efficacy and safety) and the health insurance industry.
We already have experienced the distortions of unfettered marketing in health care and should understand that a “free market” will foster hucksterism demote science and jeopardize safety in the rush to sell and profit. One only has to look at the Savings and Loan crisis of the 80’s, the Enron debacle and most recently the mortgage disaster to understand that unfettered anything in capitalism has tremendous risks. Further, the patent system that we use to “encourage innovation” actually creates monopoly and allows predatory pricing. In the end so called “free markets,” in health care, would lead to chaos and a system based solely on the ability to pay rather then fulfilling the need of all citizens, wealthy and not.
All other industrialized nations in the world have a national health insurance program. They all spend significantly less on health care per capita than we do and most have better health care outcomes as measured by the morbidity and mortality of their population. What’s wrong with that!
8. It’s Socialized Medicine: What does this hackneyed political label mean? We are a society in which over 100 million people receive health care from government sources. Our military enlist in and fight for a system of benefits for themselves that include life-long government sponsored health care. If we decide that health care is a fundamental right of our citizens, as it is in every other industrialized country, then providing health care will require some type of government participation. If we continue with our current non-system then we’ll continue to have substandard health care as measured by our statistics, millions without coverage, unnecessary morbidity and mortality in our population and exorbitant costs.
9. We need to preserve “CHOICE” in health care: This is one of the most ironic of objections because the issue is not really choice of provider or insurer but rather whether or not a person has easy affordable access to care. In the current system if you have money or insurance you have access. Almost 50 million people are currently shut out of care–and therefore have no choice.
A universal health care system corrects the “lack of choice” of the current system. Nothing, of course, changes for the wealthy. All others will have access to affordable care through some type universal insurance scheme–probably no significant change for the majority of Americans. The 50 million uninsured problem will disappear. Costs will be controlled by limiting administrative duplication, careful negotiation of prices of new drugs and technology, tweeking the patent system and institution of a system that not only values quality of care but also efficiency. We may even be able to save money.
Medicynic 