Thinking More Clearly About Our Health Care Options
C.
William Keck, a physician and the former director of the Akron Health Department,
provides a thoughtful analysis of our distorted debates about health care and how we might better understand our options.
Our political discourse has
been so poisoned by partisan bickering that it is increasingly difficult for
many to pay attention to independent voices who seek to debate the major issues
of our time based on facts and pragmatism rather than political ideology. There
is no better example than the noise generated by those who oppose the Patient
Protection and Affordable Care Act.
The May 1 letter by Loretta
Hurite (“On the way to tyranny”) is a good example of the many
misunderstandings that pervade the ranting back and forth about this issue. Of
course, no health system is perfect. No matter how good a health system is,
people will complain about it, and it is easy to cherry pick negative comments
if your wish is to disparage.
A dispassionate look by the
World Health Organization at the health systems of its 191 member nations
ranked the United States 37th in overall effectiveness, far from the best
system in the world (France was first; Cuba, 39th).
We have few peers in
high-tech interventions, but we are plagued with the highest costs per person
in the world, limited to no access to health services for many and huge
disparities in health status among our citizens.
Actually, it is a misnomer to
call medical services in the U.S. a “system.” We actually have a hodgepodge of
approaches.
Most Americans believe our
military and our veterans deserve the best medical care. The Veterans
Administration, a completely socialized system in which the government employs
the providers and owns the facilities just like in Great Britain and Cuba, is
well-regarded, and most veterans are pleased with the care they receive.
To take care of the elderly,
poor and other special groups, Medicare and Medicaid were established. These
are government insurance programs that pay for care delivered by private
providers, just as is the case in Canada. This is not a socialized system, and
it is very efficient.
Overhead costs are about 4
percent, with private insurance plans coming in at three to five times that
amount. The one thing most Americans look forward to about their 65th birthdays
is that they will then have health insurance. Canadians have that assurance
from birth.
The majority of Americans
with health insurance are covered by private insurance policies, usually
financed jointly by employers and employees. This is the model followed by
countries such as Germany and Japan, although, unlike in this country,
insurance markets are very tightly regulated there to keep costs down and
services uniform.
That still leaves about 16
percent of our population (about 50 million people) with no coverage at all,
just like the majority of residents of Burundi or rural India.
Far from being socialized
medicine, the Affordable Care Act expands Medicare and Medicaid to increase the
numbers of Americans with government-based insurance and delivers an additional
20 million people into the private insurance market.
It also begins to shift
provider incentives by emphasizing health promotion and disease prevention and
encouraging collaboration across providers to improve the quality and
effectiveness of both primary and specialty care.
It is a significant first
step to bring us closer to the universal access to effective health care that
every other industrialized nation has in place, and to improve the level of health
we enjoy.
