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Rethinking how we deliver health care

Written By | Apr 6, 2017

WASHINGTON, April 6, 2017 — The failure of the Republican health care plan, which would have increased the number of uninsured people by 24 million over the next decade, according to the nonpartisan Congressional Budget Office, has made it clear that the time has come for Americans—liberals and conservatives, Republicans and Democrats—to re-think how we deliver health care.

The U.S. is home to some of the world’s best medical schools, doctors, research institutes and hospitals. If you are able to afford the coverage and procedures you want, you can receive the very best care. But if you are unable to do so—which is the case for millions of Americans—you are at a disadvantage not suffered by the citizens of any other advanced country.

Every other wealthy, capitalist country has decided that some form of universal health care is the most sensible and effective option.  According to the latest report of the Organization for Economic Cooperation and Development (OECD), the club of 35 developed nations, the U.S. has shorter life expectancy, higher infant mortality  and fewer doctors per capita than other wealthy country.

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There are some bright spots. A report in 2014 by the Commonwealth Fund, a private foundation specializing in health care research, ranked the U.S. third in access to specialists. Only the Netherlands and Switzerland did better.

In breast cancer five-year survival rates, the U.S. comes in second after Sweden; third is Norway and fourth is Finland—all with universal health systems. For colorectal cancer, the five-year survival rate after diagnosis puts the U.S. in ninth place. Ahead are South Korea, Israel, Australia, Sweden and Finland, all with universal health care.

American women are at a significant disadvantage when it comes to cervical cancer. The U.S. comes in at 22nd.

Life expectancy at age 65 is higher in 24 other developed countries, including Canada, Britain and most European nations.

Doctors in the U.S. were more likely to report as major problems the amount of time they spent on dealing with administrative burdens related to insurance and claims. Getting medications or treatment for patients was difficult due to restrictions imposed by insurance companies, compared with the situation in ten other countries studied, including Sweden and Britain.

Americans spend far more of their incomes on health care than do citizens of any other country, by a large margin. The point of universal coverage is to pool risk to reduce the average cost of insurance to those covered by it. Universal coverage gives people more freedom, not less. No one fears being bankrupted by an illness or being unable to obtain care when needed.

According to Physicians for a National Health Program, “Single payer national health insurance, also known as ‘Medicare for all,’ is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.”

Nobel Prize-winning economist Robert H. Frank of Cornell University notes,

“Rep. Paul Ryan insisted that, by relegating health care to private insurers, competition would lead to lower prices and higher quality. Economic theory tells us that this is a reasonable expectation when certain conditions are met. A crucial one is that buyers must be able to compare the quality of offerings of different sellers.

“In practice, however, people have little knowledge of the treatment options for the various maladies they might suffer, and policy language describing insurance coverage is notoriously complex and technical. Consumers simply cannot make informed quality comparisons in this industry. In contrast, they can easily compare the prices charged by competing insurance companies.

“The asymmetry induces companies to compete by highlighting the lower prices they’re able to offer if they cut costs by degrading the quality of their offerings. For example, it’s common for insurance companies to deny payments for procedures that their policies seem to cover. If policy holders complain loudly enough, they may eventually get reimbursed, but the money companies pay by not paying others confers a decisive competitive advantage over rivals that don’t employ this tactic. Such haggling is uncommon under single-payer systems like Medicare.”

Consider the offsetting expenditures of competitive advertising and other promotional efforts of private insurers, which can exceed 15 percent of total revenue. Single-payer plans like Medicare spend nothing on competitive advertising. According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of total operating expenditures, less than one-sixth the rate estimated for the private insurance industry.

The pharmaceutical industry alone had 1,400 lobbyists in Washington in 2014.

We are spending more money on healthcare than any other country in the world, but covering fewer people. American healthcare outlays per capita in 2015 were more than twice the average of those in the rest of the OECD. Yet  the system in the U.S. delivers significantly less favorable outcomes on measures like longevity and the incidence of chronic illness.

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According to Frank,

“Advertising expenses and administrative costs are not the most important reason the U.S. spends so much more. The main difference is that prices for medical services are so much lower in other countries. In France, for example, a magnetic resonance imaging exam costs $363, on average, compared with $1,121 in the U.S.; an appendectomy is $4,463 in France versus $13,852 in America. These differences stem largely from the fact that single payers … are typically able to negotiate more favorable terms with service providers. In short, Medicare for all could deliver quality care at much lower cost than private insurers do now.”

Charles E. Bouchard, senior director for theology and ethics of the Catholic Health Association, notes that,

“Very few Americans understand how health care gets paid for. Even fewer know that we in the United States spend about twice as much per capita on health care as other developed nations, yet fewer people are insured and our outcomes tend to be worse. Ignorance of these basic facts is at the root of our stalemate about health care reform. … The only freedom the current proposal (the Affordable Care Act) projects is freedom of the market. That kind of freedom may be appropriate for buying a new toaster, but it is not appropriate for health care.”

Many Republicans have understood this for some time. As governor of Massachusetts, Mitt Romney developed a health care plan that, he said, was entirely within his party’s philosophy. He declared, “You know what?  Everybody should have insurance. They should pay what they can afford to pay. If they need help, we should be there to help them, but no more free ride.”

Requiring everyone to buy insurance on the free market and providing subsidies so lower-income citizens could afford it was a conservative idea, promoted by, among others, the Heritage Foundation.

As a candidate, Donald Trump repeatedly promised that everyone in the country would be covered at reasonable cost under his new health plan. The plan crafted by Paul Ryan and his congressional colleagues would have done the opposite—and it has failed. Some of Trump’s friends and advisers, such as conservative journalist Christopher Ruddy, are urging the president to consider supporting a single-payer system.

Conservative columnist Charles Krauthammer writes,

“A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests thar we may be heading inexorably … to a single-payer system. Don’t be surprised if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli ‘dished the Whigs’ in 1867 (by radically expanding the franchise) and joins the single-payer side.”

A question many are asking is why making sure all Americans have adequate health care is any less a legitimate function of government—fulfilling the Constitutional mandate to provide for the “general welfare”—than, say, building highways or public schools. Our medical delivery care system is broken.

Fortunately, we are now in the process of re-thinking that system. It is in the interest of both liberals and conservatives, Republicans and Democrats, to reform a failing system. Trump could put some of his current controversies behind him if he were to exercise leadership in this area.

The system we need is one which serves all Americans, not primarily the insurance and pharmaceutical companies, which now seems to be the case. The highly paid lobbyists for these commercial interests are hard at work to prevent any genuine reform. Whether or not they will succeed is yet to be seen.  History seems to be moving in a different, more hopeful direction.

Allan C. Brownfeld

Received B.A. from the College of William and Mary, J.D. from the Marshall-Wythe School of Law of the College of William and Mary, and M.A. from the University of Maryland. Served as a member of the faculties of St. Stephen's Episcopal School, Alexandria, Virginia and the University College of the University of Maryland. The recipient of a Wall Street Journal Foundation Award, he has written for such newspapers as The Houston Press, The Washington Evening Star, The Richmond Times Dispatch, and The Cincinnati Enquirer. His column appeared for many years in Roll Call, the newspaper of Capitol Hill. His articles have appeared in The Yale Review, The Texas Quarterly, Orbis, Modern Age, The Michigan Quarterly, The Commonweal and The Christian Century. His essays have been reprinted in a number of text books for university courses in Government and Politics. For many years, his column appeared several times a week in papers such as The Washington Times, The Phoenix Gazette and the Orange County Register. He served as a member of the staff of the U.S. Senate Internal Security Subcommittee, as Assistant to the research director of the House Republican Conference and as a consultant to members of the U.S. Congress and to the Vice President. He is the author of five books and currently serves as Contributing Editor of The St. Croix Review, Associate Editor of The Lincoln Review and editor of Issues.