The
U.S. spends more on health care than other countries.
In 2003, it accounted for 15.3% of the gross domestic
product, a greater percentage than Germany, France, Japan,
Italy, Canada, and other developed countries spend to
cover all their citizens. What we are getting in return
is a second rate health care system, according to Donald
L. Barlett and James B. Steele, investigative reporters,
formerly at the Philadelphia Inquirer and now editors
at large for Time magazine. What kind of a health care
system, they ask, leaves 44 million people without health
insurance and tens of millions more underinsured?
One
of America 's cherished myths is that uninsured people
eventually get health care when necessary. Yes, if they
are sick enough, say Barlett and Steele, but they will
be discharged from the hospital sooner than insured people,
often over their doctors' protests. Shockingly, hospitals
typically charge non-insured people five to ten times
what an insured person would pay for the same services.
With people who don't earn enough to pay an astronomical
bill, hospitals can play hardball. Non-profit and for-profit
hospitals alike have been known to sue, garnish wages,
and take away assets, such as a house. A catastrophic
accident or illness can bankrupt even the insured. Almost
no one knows what their health insurance pays until it's
too late. Unlike citizens in countries with universal
health care, insured Americans spend countless hours filling
out forms and questioning incomprehensible bills.
For
the last two decades, politicians have sold the American
public on the idea that the free market system is the
best way to deliver health care. But health care has always
proven to be remarkably resistant to a free market system
that thrives on selling more and more. That's the last
thing a medical care system needs, wrote the authors,
who see the goal as fewer hospitalizations, fewer consultations
with specialists, fewer diagnostic tests, and fewer prescription
drugs.
Managing
health care as a business hasn't reined in costs. On the
contrary, it rewards for overmedicating and overtesting.
Government is widely perceived as inefficient, and information
to the contrary rarely penetrates the public's consciousness.
Medicare, for example, has an overhead that averages about
2% a year; whereas the administrative costs of private
insurers is about 33%.
Quality
control is practically non-existent in a health care system
so fragmented. The 100,000 hospitalized patients who die
each year of medical errors and the additional 106,000
who die of adverse drug reactions probably represent an
undercount. No independent authority examines the records
of hospitals, doctors, and drug companies to detect such
deaths. Successful lawsuits often end in sealed documents
under secrecy agreements, thereby ensuring the mistakes
will be repeated.
Over
the last few decades, American health care has changed
radically from a system that was largely not-for-profit.
Now, the profit motive and market forces affect every
decision. Conflicts of interest are rampant. Fraud thrives
in such a system, so much so that authors think the U.S.
has not only the most expensive health care but also the
most fraudulent.
Barlett
and Steele have a remedy. It is the establishment of a
taxpayer-supported independent agency that is loosely
based on the Federal Reserve System. Like the FRS, the
proposed health agency would be run by 14 board members
appointed by the president with the consent of the Senate.
It would set an overall policy for health care and influence
its direction by controlling federal spending. This would
encompasses everything from research grants to providing
basic care for every American, as well as catastrophic
care. It would be financed by a tax on the total earnings
of all businesses and a flat tax like the Medicare tax
on people's income, not just their wages. The proposed
agency would radically reduce medical errors with the
establishment of a single information technology system
that links all hospitals, doctors' offices, pharmacies,
and nursing homes.
Barlett
and Steele believe that change is inevitable. More and
more working Americans are dissatisfied with the ever-rising
costs and U.S. companies are unable to compete in the
global market with countries that have government-funded
health care. The authors cite surveys of doctors, insurers,
and other professionals that show a marked shift in opinion
even among groups traditionally against government involvement
in health care.
Reviewed
by Maryann Napoli, Center for Medical Consumers ©
June 2005
