EDITORIAL: HEALTHCARE ISSUES—DON’T FIX WHAT ISN’T BROKEN

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"It would make little sense for the federal government to assume responsibility for the 300 million Americans who are able to fend for themselves."

By Jim Stieringer

June 15, 2009 (San Diego’s East County)--Health care in the United States is not “broken”. We need merely address the 15% not currently covered by some form of health insurance. California is both economically and politically “broken”. However its health system currently covers 24 million of its 30 million citizens. This is a remarkable achievement. A new government program need merely address the needs of those 50 million American citizens (6 million of whom reside in California) who are not currently covered by any form of insurance.

If only 15% of the population is not currently covered by an existing program (e.g. employer provided insurance, privately purchased insurance, Medicare, Medicaid, Military, Tri-Care, etc) why are we planning to throw out all of these systems?

“Health Savings Plans” are not the answer. The uninsured population includes many of our most economically disadvantaged citizens. If they were sufficiently affluent as to seek a tax shelter, they wouldn’t likely be amongst the uninsured.

“Single Payer” is a clearly discredited concept except among the most socially liberal advocates. Government control of health care is clearly discredited when viewed through the prism of the failed Canadian and United Kingdom models. Health insurance is currently a competitive market with more than 1,000 licensed health insurance companies in the United States. Do we really want the non-competitive “single payer” determining our health care?

We should first answer the basic questions:

1. Is health care an entitlement?, and
2. Is the nation’s existing system of providers and insurers “broken”?

If health care is an “entitlement”, why not lodging, why not clothing?, why not transportation?, why not entertainment?.

I argue that it would be hyperbole to describe a health care system as “broken” when it already covers 85% of the population.

Why should we believe in the Obama administration’s ten year $1.5 trillion price estimate when other government estimates have been historically low? Only the Medicare Part “D” prescription drug program is currently being operated at a cost below the initial government estimate. Medicare and Medicaid have been world-class budget busters.

Under government health care who will decide on the modality of care, the timing of care and the level of care? Most of us would agree that we should deny a liver transplant to an alcoholic, but what about the thousands of treatment options that fall below that threshold? Why should we agree to allow a government bureaucrat to decide which medical provider will provide our treatment? Why would we want an accountant to determine that the lives of senior citizens are less valuable than those of younger citizens?

It would make little sense for the federal government to assume responsibility for the 300 million Americans who are able to fend for themselves.

The Obama administration is disingenuous when it argues that 15% of the population currently lacks medical care. There is a difference between a lack of insurance and a lack of medical care. Our nation’s emergency rooms currently treat thousands of the low income uninsured each day. It is not legal to deny such care simply because the patient is indigent. The obvious answer is to provide some sort of government paid charity to those currently uninsured individuals. To do so would be far less expensive than throwing out the existing system that serves us well, even if it does not serve us perfectly.

Jim Stieringer
Board President
Grossmont Healthcare District

The opinions expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine.

Comments

If managed Care Reform is

If managed Care Reform is comparable to widening highways that involves too much detours and stuff. maybe we ought to let them go broke and start all over again... Why rebuild bridges if we can buy spanking new ferries instead?? We can never have too many ferries and ports do we? Every town circling the bays, sounds, rivers etc can have its own ferry port, why not? It is cheaper than maintaining rusty steel bridges ? Our managed care system is probably outdated already.. Why? Managed care system is supposed to tell me what not to eat or inhale, right?/ NO. they want to keep quiet so we can visit their beautiful hospitals!! Look at TV shows? Doctors and nurses actors are replacing cop shows , right?? look at HOuse, Scrubs, etc? Gumshoes are out, doctors are in.. Give us your tired, sick, weepy idiots! Where is our affordable health insurance for everybody?

If managed Care Reform is

If managed Care Reform is comparable to widening highways that involves too much detours and stuff. maybe we ought to let them go broke and start all over again... Why rebuild bridges if we can buy spanking new ferries instead?? We can never have too many ferries and ports do we? Every town circling the bays, sounds, rivers etc can have its own ferry port, why not? It is cheaper than maintaining rusty steel bridges ? Our managed care system is probably outdated already.. Why? Managed care system is supposed to tell me what not to eat or inhale, right?/ NO. they want to keep quiet so we can visit their beautiful hospitals!! Look at TV shows? Doctors and nurses actors are replacing cop shows , right?? look at HOuse, Scrubs, etc? Gumshoes are out, doctors are in.. Give us your tired, sick, weepy idiots! Where is our affordable health insurance for everybody?

Response to DON’T FIX WHAT ISN’T BROKEN

Response to EDITORIAL: HEALTHCARE ISSUES—DON’T FIX WHAT ISN’T BROKEN by Jim Stieringer:
Joel A. Harrison, PhD, MPH

The following response is quite long. It needs to be because platitudes and myths can only be revealed by real data and logically developed argument. Although long, for those who really want to understand the flaws in Mr. Stieringer’s argument, for those who really want data to base their opinions and actions on, I believe the time spent reading what I have to say will be well worth their while. I have included extensive references including URLs to the articles and papers when available on the web.

Mr. Stieringer paints a picture of our current health care system through rose-colored lenses, distorted by myth. According to him only 15% of Americans are uninsured. Implicitly, he would like us to believe that those who are insured are “protected” against the risks of illness and injury. First, during any given year up to 100 million Americans are either un- or underinsured for some period of time, that is approximately 33% of Americans, more than double his figure. The underinsured delay seeking care because of high deductibles and co-pays. People can be uninsured for a variety of reasons. They can be downsized. They can begin a new job that has a 3 – 6 month waiting period before becoming eligible for health insurance. Or, they can be “well-insured;” but lose their coverage after a long illness or injury. If ill or injured beyond cumulated sick and vacation leave (if your job offers such), one loses their insurance. Of course, COBRA allows one to continue coverage for up to 18 months, and in some states even longer, that is, if while sick or injured with a significantly reduced income one can afford COBRA. So just when coverage is needed most, it is lost. Currently, 60% of all personal bankruptcies in the U.S. are due to medical expenditures (for examples of the above start with Donald Barlett and James Steele’s book, “Critical Condition: How Health Care in American Became Big Business & Bad Medicine, Doubleday, 2004).

A recent report from The Commonwealth Foundation found the following:
"The beneficiaries of reforms that ensure affordable health insurance and access to high-quality care would include:

a. 46 million who were uninsured at the start of the recession, and 55 million who
were uninsured at some point during the past year;
b. 25 million working-age adults who are underinsured;
c. 72 million working-age adults who have difficulty paying medical bills;
d. 49 million small business employees who now pay higher premiums than employees in
larger businesses;
e. 4 million adults under age 65 with individual coverage whose premiums go toward high
overhead costs, leaving less room for benefits;
f. one-third of insured people who change plans frequently, often not by choice;
g. 46 percent of workers with employer coverage who do not have a choice of plans;
h. Medicaid beneficiaries, who would have expanded choices and better access to care if
Medicaid provider payments were increased;
i. women, who as a group carry greater financial burdens from health care expenses;
j. 13 million young adults without coverage;
k. older adults and early retirees, who have few affordable insurance options;
l. 2 million disabled individuals in the waiting period for Medicare coverage;
m. any Medicare beneficiary who now pays high hospital deductibles or high premiums for
supplemental coverage; and
n. 37 million adults and 10 million children who lack easy access to a regular source of
care."

(Karen Davis et al. “Front and Center: Ensuring that Health Reform Puts People First,” June 11, 2009, volume 113, http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/J...)

OVER 65% OF HEALTH CARE IN U.S. IS FUNDED THROUGH TAXES:

Mr. Stieringer asks if health care should be considered an “entitlement.” What he fails to understand is that over 65% of health care expenditures are paid for by taxes. Over 75% of the uninsured live in families with at least one member working. In essence, the un- and underinsured are subsidizing the rest of us through their taxes (See my article in Dollars and Sense Magazine, “Paying More, Getting Less: How Much is the Sick U.S. Health Care System Costing You?” http://www.dollarsandsense.org/archives/2008/0508harrison.html).

EFFECTS OF UN-INSURANCE AND UNDERINSURANCE ON COSTS AND EMERGENCY CARE:

Being un- or underinsured leads to costly serious conditions that could have been avoided had one a family doctor. Preventive medicine and good maintenance of chronic conditions not only prevents or delays more costly conditions; but creates a more productive citizenry (Statistical Brief #5: Medical Care and Treatment for Chronic Conditions, 2000, http://www.meps.ahrq.gov/mepsweb/data_files/publications/st5/stat05.pdf).

A recent study found the following: “A 2008 survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States found major differences in health care access, safety, and efficiency, with U.S. patients at particularly high risk of forgoing care because of costs and experiencing errors or inefficient, poorly organized care (Cathy Schoen et al. “In Chronic Condition: Experiences of Patients with Complex Health Care Needs, in Eight Countries, Health Affairs Web Exclusive, November 13, 2008, w1-w16, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.1.w1v1?...).

And according to another recent study, “previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured. (J. Michael McWilliams et al. “Use of Health Services by Previously
Uninsured Medicare Beneficiaries,” N Engl J Med 2007;357:143-53, http://content.nejm.org/cgi/content/full/357/2/143/F1). One can easily extrapolate these findings to the underinsured.

So not only do the vast majority of the un- and underinsured already subsidize our health care system through their taxes; but because they are either un- or underinsured they cost us more.

And worse, the un- and underinsured clog our emergency rooms. According to a recent report from the Institute of Medicine:

"Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation's emergency medical system as a whole is overburdened, underfunded, and highly fragmented. As a result, ambulances are turned away from emergency departments once every minute on average and patients in many areas may wait hours or even days for a hospital bed. Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, terrorist attacks, or disease outbreaks." Institute of Medicine. "Hospital-Based Emergency Care: At the Breaking Point" June 14, 2006 at http://www.iom.edu/CMS/3809/16107/35007.aspx

The above puts all of us at risk, regardless of how well insured we are. And who hasn’t heard the stories of delays and denials from some insurance company bureaucrat at the end of an 800 number (see reference to Barlett and Steele above).

IS SINGLE-PAYER "DISCREDITED?" INTERNATIONAL COMPARISONS ON QUALITY AND OUTCOMES:

According to Mr. Stieringer “Single Payer is a clearly discredited concept except among the most socially liberal advocates. Government control of health care is clearly discredited when viewed through the prism of the failed Canadian and United Kingdom models. Health insurance is currently a competitive market with more than 1,000 licensed health insurance companies in the United States.”

What does he mean by “discredited?” Is he referring to the propaganda and hype, the gross distortions promulgated by our for-profit health care industry directly and through funding of right-wing ideological think tanks? Or is he referring to international comparative studies of process and outcomes data? And single-payer is not a “government controlled system of health care.” It is government financed health care, Medicare plus, with actual care delivered in the private sector; but I’ll get back to this, first, let’s look at just some of the data.

a. Infant Mortality:

According to a recent report from the U.S. National Center for Health Statistics (http://www.cdc.gov/nchs/data/hus/hus07.pdf#025), for 2004, infant mortality in Canada was 5.3 per 1,000 live births, England (United Kingdom) was 5.0, France was 3.9, Germany was 4.1, Sweden was 3.1, and the U.S. was 6.8.

b. Life-Expectancy:

On life-expectancy based on year 2009 estimates, Canada has 81.23 years, England (United Kingdom) has 79.01, France has 80.98, Germany has 79.26, Sweden has 80.96, and the U.S. 78.01 (CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/rankorder/21...). Based on 2001 data, years of life-expectancy at age 65: Canada (men 17.1, women 20.5); England (men 16.1, women 19.0); France (men 16.9, women 21.2); Germany (men 16.0, women 19.4); Sweden (men 16.9, women 20); and the U.S. (men 16.4, women 19.2). The U.S. ranked 12th in life-expectancy for men and 15th in life-expectancy for women from age 65. compared to its ranking of 25th for men and 26th for women from birth (http://www.cdc.gov/nchs/data/hus/hus05.pdf#page=182). Note. U.S. life-expectancy ranking improve once people are covered by Medicare; see also USA Today “Life-expectancy lags behind 41 nations.” http://www.usatoday.com/news/health/2007-08-11-life-expectancy_N.htm).

c. Deaths from Treatable Conditions:

According to a recent study “One measure of the health of Americans—deaths from treatable conditions—still does not compare well with rates in other industrialized countries. . . Applying the corresponding death rates to the U.S. population, we estimated that between just under 75,000 deaths (average of eighteen OECD countries) and just over 101,000 deaths under age seventy-five could be saved in the United States.” (Ellen Nolte et al “Measuring The Health Of Nations: Updating An Earlier Analysis,” Health Affairs, Vo l u m e 2 7, Nu m b e r 1, J a n u a r y/ F e b r u a r y, 2 0 0 8, http://content.healthaffairs.org/cgi/content/abstract/27/1/58?ijkey=05uD...).

d. Cancer Survival:

The propaganda industry was in full force following recent studies of cancer survival in Europe and the U.S. One study concluded that “For all solid tumours, with the
exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000–02 was higher in the US SEER registries than for the European mean.” Please key in on the phrase “European mean.” This includes all European countries including the Eastern European poorer members of the European Union. Read the paper more closely and survival rates differ little between Scandinavian, German, French patients and those in the U.S. In addition, survival statistics are often muddied by what we epidemiologists call “lead-time bias.” Imagine that once symptomatic, survival on a particular type of cancer is, on average, one year. Now imagine that one develops some new diagnostic procedure that finds the same cancer one year prior to its becoming symptomatic with the result that survival following the earlier diagnosis becomes two years. In actuality survival time has not changed. With certain forms of cancer, the U.S. does more screening than some other nations; but survival times have NOT changed. In fact, if earlier treatments do not really improve survival, in effect, quality of life has been diminished because of undergoing treatments earlier on.

England's Survival Data:

England did have lower survival than other Western European nations and the U.S; but the studies also showed that survival statistics in England have shown a steady improvement. (Arduino Verdecchia et al. “Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data,” The Lancet, Vol. 8 Issue 7, September 2007, http://www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/ab...
Franco Berrino et al. “Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study,” The Lancet Vol. 8 Issue 7, September 2007, http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(07)70245-0/abstract.

One of the things that opponents of single-payer do is pick and choose statistics that show problems in other healthcare systems. If survival for one type of cancer is lower in some country than in the U.S., they pick that statistic and ignore data where that country does better than the U.S. They also pick data from different countries. Unfortunately, no one has the perfect system and if one looks hard enough one can find anything; but the old saying is “the exception proves the rule,” applies here. While England does do worse on cancer survival, it does better on chronic condition care than in the U.S., and as the above studies show, has made great strides in improving cancer survival as well. Finally, infant mortality data is much better than in the U.S. and life-expectancy is also better. What also needs to be understood is the context. When Margaret Thatcher and the Conservatives came to power their goal was to privatize the British Health Services; but they didn’t dare because of its immense popularity. Instead, they chose to “starve the beast,” cut funding to a level that drove personnel away and allowed facilities and equipment to deteriorate, along with less purchasing of newer equipment and technologies. At one point England only spent 6% of her GDP on health care, half what we spent. When the Labor Party took power they began revitalizing the system which shows from the improvements in cancer survival and also major decreases in waiting times. Currently England spends, as of 2006, 9.4%. (Anne Griffin. “UK nears European average in proportion of GDP spent on health care,” BMJ 2007;334:442,3 March, http://www.bmj.com/cgi/content/extract/334/7591/442). While this is much lower than what we spend on health care in the U.S., the difference in process and outcomes measures display a much more efficient system and England continues to make improvements. Imagine their system if they spent even near as much as we do?

f. Avoidable Medical Errors:

Avoidable medical errors reveal again that the U.S. ranks poorly internationally. From a report based on two surveys of patients: “the first conducted in 2004 among a nationally representative sample of adults in Australia, Canada, New Zealand, the United Kingdom, and the United States; the second conducted in 2005 among a sample of adults with health problems in the same five nations and Germany, the results found that “Among sicker adults, Americans had the highest rate of receiving wrong medications or doses in the prior two years. Among sicker adults who had a lab test in the past two years, adults in the U.S. were more likely than their counterparts in the other countries to have been given incorrect results or experienced delays in notification about abnormal results, with rates double those reported in Germany or the U.K. Rates of lab errors were also relatively high in Canada.” (Karen Davis et al. “Mirror, mirror on the wall: An update on the quality of American health care through the patient’s lens.” The Commonwealth Fund, April 2006, http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/A...). And according to our Institute of Medicine “Health care in the United States is not as safe as it should be--and can be. . . . as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented.” (Institute of Medicine, “To Err is Human: Building a Safer Health System,” 1999, http://www.iom.edu/?id=12735).

Someone might try to refute the above statistics by claiming that the other countries are more homogeneous than we are. The percentage of foreign born are: Canada 19.3%, England (United Kingdom) 8.3%, France 10.0%, Germany 12.5%, Sweden 12%, U.S. 12.3%. Note that Germany has slightly more foreign born that the U.S. and Canada a much higher percentage. (OECD, “Counting Immigrants And Expatriates in OECD Countries: A New Perspective” 12 March 1005 - http://www.oecd.org/dataoecd/27/5/33868740.pdf

RATIONING:

As already discussed, the lack of insurance leads to more costly care later on and affects productivity. With a single-payer system many costly conditions will be avoided by more preventive care and better maintenance of chronic conditions. In addition, it is estimated that at least 1/3 of all medical interventions don’t work or even cause more harm than good. Not only will the approximately 25 cents of every health care dollar currently funding our fragmented dysfunctional health care system be returned to actual health care; but by having a single electronic record, teams of health service researchers and epidemiologists will be able to carry out evaluations of care not currently possible. In some cases the data will be so clear that some current care will be eliminated. In other cases the data will lead to hypotheses to be tested with randomized clinical trials. In addition studies estimate that doctors spend up to 2 hours each day dealing with insurance and insurance companies, time that could be devoted to patient care. In France and other countries patients see doctors more frequently and each visit is longer than in U.S.

Numerous studies have found that we have more than enough money to cover all scientifically proven treatments that actually confer benefit.“Health systems world wide are grappling with the problem of explicit or implicit rationing of health care resources. Such efforts are commonly informed by the pessimistic belief that the satisfaction of demand is in truth an unrealistic goal . . . The assumptions that underlie this pessimism should be questioned, and abandoned in favour of empirical determination of health care requirements, with the assumption that there may be no need to ration those interventions of undoubted efficacy.” (Stephen Frankel, “Health Needs, Health-Care Requirements, and the Myth of Infinite Demand,” The Lancet, Vo. 337. June 29, 1991, pp 1588 – 1590; see also Richard Greene, “The National Medical Effectiveness Research Initiative: The Search for What Really Works in Treating Common Conditions, Diabetes Care, Vol. 17, Supplement 1, June 1994, pp 45 – 49, http://www.ncbi.nlm.nih.gov/pubmed/8088223; Gray Ellrodt et al. “Evidence-Based Disease Management, JAMA, Nov 26, 1997, Vol 278, No. 20, pp 1687 – 1692, http://jama.ama-assn.org/cgi/content/abstract/278/20/1687; Michael L. Millenson. “Demanding Medical Excellence: Doctors and Accountability in the Information Age,” The University of Chicago Press, 1997; and especially check out the website of the Agency for Healthcare Research and Quality at http://www.ahrq.gov/).

WAITING TIMES:

Alleged delays in care received in other countries are often played up. Unfortunately, again this is selectively choosing some data and, even worse, exaggerating outliers.
One study found that “Germany and the U.S. stand out among the six countries in terms of patients with health problems reporting the least difficulty waiting to see a specialist
or have elective or non-emergency surgery. Yet Americans, along with Canadians,
were more likely to say they waited six days or more for an appointment with a doctor or had trouble getting care on nights and weekends. Across all five measures of timeliness, Germany and New Zealand ranked first and second, respectively. The U.K. ranked fifth, and Canada ranked last. (ibid)

And while other countries are making improvements in both care and wait times, the situation in the U.S. is deteriorating. “A study by Merritt Hawkins and Associates shows that appointment wait times have increased on average by more than a week since the survey was last conducted in 2004. Merritt Hawkins, a consulting firm that specializes in recruiting physicians and other health care professionals, surveyed more than 1,150 medical offices in 15 cities. The survey measured average appointment wait times in family practices as well as four specialties: cardiology, dermatology, obstetrics/gynecology and orthopedic surgery. The survey found that, on average, wait times have increased by 8.6 days per city. Boston had the longest wait, averaging 49.6 days, followed by Philadelphia with 27 and Los Angeles with 24.2. The shortest was Atlanta with an 11.2-day wait. In all cities among all the specialties, the wait was 20.5 days.”(Merritt Hawkins & Associates. “2009 Survey of Physician Appointment Wait Times.” http://www.merritthawkins.com/pdf/mha2009waittimesurvey.pdf; Erin Thompson. “Wait Times to See Doctor are Getting Longer.” USA Today, June 3, 2009 http://www.usatoday.com/news/health/2009-06-03-waittimes_N.htm). This does not include the delays and fighting denials experienced by many Americans (e.g. Barlett and Steele’s book “Critical Condition) nor the delays in seeking care by the un- and underinsured.
Our for-profit health care system propaganda mill especially likes to play up waiting times in Canada.

As this paper is getting quite long, a brief summary will have to suffice. Canada, like England, experienced significant cuts to their Medicare program when the Conservative Party was in power some 20 years ago. Even so, the reports of long waiting times were grossly exaggerated. Individual anecdotes do not prove anything. There were cases of unacceptable delays; but compared to what? As I’ve written above, we have delays in our system, especially for the un- and underinsured. An estimated 22,000 Americans die yearly because of lack of health insurance. (Urban Institute. “Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality,” 2008, http://www.urban.org/publications/411588.html) This figure doesn’t include all the suffering from reduced quality of life which in turn obviously affects productivity thus negatively impacting our economy.

First, the statistics on waiting times in Canada are mainly based on studies by the Fraser Institute, a Libertarian think tank located in Vancouver. Numerous other studies have found that, while there are waiting times, they are far shorter than the Fraser Institute studies claim. In addition, since 2003, the Canadian government has been investing huge sums of money into improving both quality of care and waiting times with significant improvements already showing. In fact, in some parts of Canada, some medical procedures can be obtained faster than in the U.S. You can find information about this effort in a recent report, “Rekindling Reform: Health Care Renewal in Canada, 2003 – 2008,” June 2008, http://www.healthcouncilcanada.ca/docs/rpts/2008/HCC%205YRPLAN%20(WEB)_FA.pdf. For methodological difficulties in measuring wait times see Claudia Sanmartin et al. “Waiting for medical services in Canada: lots of heat, but little light,” CMAJ, May 2, 2000, Vol. 162, No.9, pp 1305 – 1310. http://www.cmaj.ca/cgi/reprint/162/9/1305. For examples of projects that have improved wait times see Michael M. Rachlis. “Public Solutions to Health Care Wait Lists.” Canadian Centre for Policy Alternatives, December 2005. http://www.policyalternatives.ca/documents/National_Office_Pubs/2005/Hea... and for current data on wait times see Wait Time Alliance April 2007 Report Card http://www.waittimealliance.ca/images/report_card.pdf;
and Canadian Institute for Health Information. Wait Time Tables: A Comparison by Province, 2007
http://secure.cihi.ca/cihiweb/en/downloads/aib_provincial_wait_times_e.pdf)

PUBLIC GOODS VS. COMPETITIVE MARKET COMMODITIES:

Any standard economics textbook discusses public goods and externalities. A public good is something that either can’t be obtained by individual effort or can be provided more efficiently by the community. Obviously, police and fire protection come to mind as well as schools and public health. Externalities refer to costs that individuals do not include in their calculations. One externality caused by our health care system is putting our companies at a disadvantage internationally. For instance, an auto manufactured in Detroit costs about $1,600 more than one manufactured in Ontario. In addition, our economy is less productive because of “job lock.” Job lock simply means that people either stay at jobs or seek jobs because of health insurance rather than jobs best suited to their talents and skills. Another externality is that children experiencing health problems do more poorly at school and, thus, become less productive citizens. The externality is that the profits of the health insurance industry costs us big time, including poorer outcomes and diminished productivity and international competitiveness. If the health insurance industry improved the quality or timeliness of health care then maybe there would be a trade-off; but they don’t. In fact, all they do as serve as middle-men that negatively affect the quality and timeliness of health care.

As mentioned above, we already pay more than 65% of health care through taxes in the U.S. Additionally, about 15% of health care is out-of-pocket, e.g. deductions, co-pays, and non-insured expenses. This sums to about 80% which as a percentage of GDP is higher than health care costs in any other nation in the world; yet, as I have shown above, we do poorly on almost every measure, e.g. infant mortality, life-expectancy, outcomes on treatable conditions, and even wait times (that is, if one doesn’t pick and choose one or two countries with universal non-profit health care; but looks at all of them). So, in essence, we already pay for health care through taxes and out-of-pocket and then give 20 – 25% of every dollar to keep a parasitic non-beneficial private health insurance industry in business. In a book by Dr. Michael Rachlis (which is available to download for free on the Iinternet), he gives numerous examples from around the world, including from the U.S., of programs that have improved the quality and timeliness of health care, all easier to carry out in a single-payer system (Michael Rachlis, MD, “Prescription for Excellence,” www.michaelrachlis.com).

Health care does not function as a competitive market consumer good. It is a public good. None of the major assumptions underlying market models apply to health care, e.g. information asymmetries, etc. Several economists have written clear expositions of why health care does not work as a market consumer good, among these are Nobel prize winning economist Kenneth Arrow in an article entitled “Uncertainty and the Welfare Economics of Medical Care,” The American Economic Review, Volume 53, No. 5, December 1963, pp 141 – 149. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf and Thomas Rice in his book “The Economics of Health Reconsidered,” Health Administration Press, 1998. A new edition is due out the end of this summer. Even F.A. Hayek, considered the founder of free market economics, wrote in his seminal work, “The Road to Serfdom,” “Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance—where, in short, we deal with genuinely insurable risks—the case for the state’s helping to organize a comprehensive system of social insurance is very strong.”

Hayek was about as rabid anti-government as one can find; yet he understood the difference between consumer and public goods. Single-payer is the “comprehensive system of social insurance” that he refers to for sickness and accident.

SINGLE-PAYER WILL COST US LESS AND GIVE US MORE CHOICE:

While recent polls show than more than 70% of Americans are willing to pay higher taxes to ensure everyone has health care coverage, with single-payer a Medicare-like tax will be the main source of revenue, costing less than our current premiums and out-of-pocket costs. We will choose our doctors and hospitals. All scientifically proven medical interventions and drugs will be covered. Since everyone will be in the system, everyone will have a vested interest in seeing that it works and works well. All of the current plans before Congress call for additional funds in the trillions to cover more people; but why? We already have more than enough. Several studies have shown that only single-payer will not increase costs, is best at controlling health costs increases, and will provide the highest level of care represented by the best of our current private health insurances (see GAO/HRD-91-90. “Canadian Health Insurance: Lessons for the United States,” June 1991. http://archive.gao.gov/d20t9/144039.pdf; Congressional Budget Office. H.R. 1200, American Health Security Act of 1993, December 16, 1993. https://www.cbo.gov/ftpdocs/79xx/doc7945/93doc08b.pdf; The Lewin Group, “The Healthcare for All Californians Act: Cost and Economic Impact Analysis”, January 19, 2005. http://www.healthcareforall.org/lewin.pdf).

CONCLUSION:

What is sometimes disconcerting is that most Americans are aware of the problems in our health care system. In fact, polls show consistently that despite all the negative press about Canada and other universal non-profit systems, most Americans want a single-payer system. Despite what Mr. Stieringer writes our system is broken. Actually I shouldn’t say our “system,” since what we have is a dysfunctional fragmented costly wasteful non-system with poor results.

It isn’t surprising that we are inundated with lies and distortions about other health care systems. How many remember the lies of our tobacco industry. From the 1950s they fought tooth and nail to maintain their profits. They hired PR firms, gave funding to pro-business right-wing think tanks, even created their own research projects, all to convince the public that they, as responsible corporate citizens, would never market a product that would harm their customers. Of course, everyone knows they lied. One of their themes was “choice.” Don’t let the government run your lives (for the history of the lies of the Tobacco Industry see Allan M. Brandt’s recent book, “The Cigarette Century: The Rise, Fall, and Deadly Persistance of the Product that Defined America,” Basic Books, 2007). Gee, isn’t that what the health insurance industry tries to convince us of? But in fact, it is the health insurance companies that cherry pick, that delay and deny care, that drive up the costs with unnecessary administrative complexities and profits, that create a complex fragmented system that inhibits coordinated care, and makes research on health care improvements more difficult. They make enormous profits at our expense and just as the Tobacco Industry, want to maintain these profits.

We all know that Mr. Stieringer is wrong, dead wrong for the many who suffer unnecessarily because of our current health care system. Unfortunately, Americans, like people everywhere, like to think their culture, their nation is better than others. We, as Americans, have been told this over and over again going back to the Puritans “City on the Hill.” So, despite what we know is wrong with our system, we succumb to the lies and distortions about other systems because deep down we would like to believe that whatever is wrong here, it is worse elsewhere. Given the actual data and research, we know this is not true; but how many have the time to really study in depth health care? Instead we fall victim to the old adage, “the lie told the most becomes the truth.” Mr. Sieringer is just one more proponent of the “lie,” that our health care system is essentially sound and just needs some minor adjustments. Either he is just regurgitating the same propaganda we have all been exposed to or he knows otherwise; but has a vested interest that diverges from the rest of us. It really doesn’t matter which. Our health care system is BROKEN.

For additional information on single-payer, go to Physicians for a National Health Programs website at www.pnhp.org. Start with “Frequently Asked Questions.”