July 30 marks the 44th anniversary of Medicare providing healthcare to all over the age of 65. That system has provided a safety net to all of our seniors, irrespective of their ability to pay. As a single-payer system with the lowest administrative costs, it has proved the most cost-efficient for our nation.
It is the most fair and moral way to deliver healthcare.
When you get sick, you get care and the bill is paid. Nothing could be simpler.
Prior to Medicare, the whims of health, illness, luck and infirmity were the gamble facing the oldest segment of our population. Today, that same dilemma faces more than 45 million Americans - yes, 1 in 6 without health insurance.
According to a 2004 report by the Institute of Medicine of the National Academy of Sciences, this has resulted in the deaths of 50 Americans each and every day because they lacked health insurance! That is more than 18,000 American lives lost every year, not from war or the H1N1 flu pandemic, but lack of health insurance. Additionally, an estimated 50 million Americans have inadequate insurance, putting them in the precarious position of being one illness away from health or financial disaster.
As practicing physicians, every day, we face decisions of how to provide the best healthcare to our patients. Let there be no misconception. Our current system rations care based on financial means and ability to pay. Even those with coverage face the idiosyncrasies and gaps of health-insurance companies.
This was perhaps best said in recent testimony before the U.S. Senate Committee on Commerce, Science and Transportation by Wendell Potter, former head of corporate communications at Cigna: "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers and they make it nearly impossible to understand - or even to obtain - information we need."
These realities do affect outcomes and severity of illness, resulting in higher costs. In the words of former Surgeon General Dr. Joycelyn Elders, the U.S. has the best "sick care" in the world. This has also resulted in the most expensive care in the world. The excess costs are paid by all of us - each individual and business each and every day. We pay in cost-shifting, bankruptcy costs and, lastly, when businesses add their employee health costs to their product price and we reimburse them at the cash register.
Two-thirds of U.S. bankruptcies in 2007 were due in part to medical bills or illness, amounting to 1 million bankruptcies annually. Three-quarters of these individuals had insurance at the onset of their illness.
Healthcare is the fastest-growing part of our economy, currently consuming 18 percent of gross domestic product and growing. This is not sustainable.
How should we respond to this unacceptable and unethical dilemma? There is a solution to provide cost-effective, comprehensive healthcare to all. A reformed "Medicare for All," as embodied in Rep. John Conyers' bill (HR 676 in the House) with its 83 co-sponsors, provides the answer. This proposal involves removing the insurance company middlemen from the healthcare equation, substituting a "Medicare for All" single-payer program. This provides public financing with a private delivery system. Polls show that 62 percent of the public and 59 percent of physicians support this option.
How will it be paid for?
It is estimated that private insurance companies spend 31 percent of premium dollars on administration compared with 3 percent for Medicare. This amounts to approximately $400 billion annually in excess of the administration costs of the Medicare program. Under a single-payer "Medicare for All" program, these dollars would be put to healthcare delivery.
The estimated costs of the current healthcare-insurance proposals being considered by Congress (and used to engender fear by the opposition and vested interests) amount to $100 billion to $150 billion annually - far less than the expected savings amounting from a single-payer system. Thus, coverage for all under this plan would provide better care with far greater savings.
In addition, choice of physician and hospital would be maintained. Also, the focus would be changed to wellness and preventative health.