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.