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July 6, 2007 at 12:13:44

In The Ambulance Together

by Todd Huffman, M.D.     Page 1 of 2 page(s)

www.opednews.com

 

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It's no secret that the American health care system is sick. So sick that we spend more, twice as much more per person, on health care as citizens of other advanced countries, yet we get less, and are less healthy besides.

The U.S. does not have the world's best care. It has the costliest.

Our health care system is so dysfunctional and unjust that one in six Americans, including some nine million children, go without health care twelve months out of the year. One in three Americans below age 65 lack private or public health insurance for all or part of the year. Six of ten of these uninsured adults even hold full-year, full-time jobs.

And, not surprisingly, since 2001 the number of Americans falling through the cracks of our broken health care system has been steadily rising.

Also not surprisingly, uninsured Americans receive about half the medical care of those with insurance. They receive too little care too late, get sicker, and die sooner. Roughly 18,000 excess deaths occur each year in this nation of plenty among uninsured adults age 25 to 64.

Put in contemporary terms, lack of health care is clearly killing many more Americans than terrorism. The real wolf at the door is not the one purportedly roaming the mountains of western Pakistan.

Being without health care means that when a child gets sick, the parents don't take them to the doctor. They wait, and hope their child will get better. People without health care don't treat their diabetes. They don't get a Pap smear, or a mammogram. They ignore the pain in their chest. All this adds up to a less healthy society.

Health and health care are vitally important in influencing life's chances. That so many people should be without medical coverage in the world's richest country is a disgrace. It blights the lives of the uninsured, who suffer by being unable to get access to affordable treatment at an early stage. And it casts a shadow of fear well beyond, to people in America's middle class, who worry about losing not just their jobs but also their health care benefits.

Having health care benefits does not necessarily guarantee peace of mind. Premiums are soaring, while benefits are shrinking. Millions upon millions of working Americans with health insurance have benefits so insufficient that they are not able to meet the financial consequences of major illness, which has become the nation's leading cause of personal bankruptcy.

As a full-time primary care physician practicing in a blue-collar community in Oregon, daily and nightly I listen as families tell the stories, the symptoms, of our sickly health care system.

I hear stories of friends and congregations holding garage sales and charity breakfasts to help a family with medical expenses; of uninsured families bartering skilled services for medical care; and of families with health insurance but living paycheck to paycheck, unable to fill prescriptions, complete recommended treatment, or even see a doctor when ill because their co-pays are too high.

All this in a community neither especially poor, nor without good jobs.

How can the U.S spend so much more and get so much less out of its health care system? With five percent of the world's population, the U.S. accounts for nearly fifty percent of the world's healthcare spending, while ranking just 29th in the WHO life expectancy ranking, and 37th in child mortality under age 5. We even rank near the bottom of countries with indoor plumbing when it comes to physicians, nurses, and hospital beds per person.

All this in a country neither especially poor, nor without good jobs.

And things are soon to get worse. Much worse. The combination of an aging society and fast-rising health care costs means that health care spending is slated to sop up much, much more of our future resources than Social Security.

Within a decade, an aging America will spend one of every five dollars on health care: the nation's total health care bill by 2015 will be more than $4 trillion. Consumers will foot half the bill, the government, and therefore taxpayers, the rest.

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Todd Huffman is a pediatrician and writer living in Eugene, Oregon. He is a regular contributor to many newspapers and publications throughout the Pacific Northwest.

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6 comments

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Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

tabonsell*****************************************************



Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

AGREE, DISAGREE

That our health-care system (not to be confused with health-care technology) is a total shambles should not a question any longer. On that, we can agree.

But I don't agree a universal system is the answer; I propose a dual system in which every resident will be enrolled in an HMO by each state. HMOs would concentrate on preventative care, diagnosis and some outpatient care. With 300 million people in HMOs, hundreds of thousands of new jobs would be created to replace those that could be lost in other areas.

All Americans can then also be enrolled in Medicare which would cover hospitalization, recovery, recuperative and rehabilitation treatment. With everyone in HMOs at the state level, much of present-day Medicare can be eliminated.

Vanity and elective medical procedures would remain outside these systems, and all would continue to use private-sector entities. We might even be able to downsize the VA hospital system, retaining only that which applies directly to military injuries.

We are already paying for a wasteful system, so paying for an efficient system would be no problem.

At present, no one gets free medical coverage from an employer; medical coverage is paid for with what is called "diverted compensation." That is, money earned on the job by employees but which is diverted to a third party ~ an insurance company ~ rather than paid directly to those who earned it.

All present reforms kicked around by politicians involve messing with the tax code and making it even more cumbersome and confusing than it already is.

.....................

PS: Always though Eugene to be an intellectual yuppie village, rather than a blue-collar town. My hometown of Bend was blue collar before it got all touristy.

by tabonsell (28 articles, 0 quicklinks, 22 diaries, 250 comments) on Friday, July 6, 2007 at 1:42:49 PM
 


Todd Huffman is a pediatrician and writer living in Eugene, Oregon. He is a regular contributor to many newspapers and publications throughout the Pacific Northwest.
Todd Huffman, M.D.Todd Huffman is a pediatrician and writer living in Eugene, Oregon. He is a regular contributor to many newspapers and publications throughout the Pacific Northwest.

Thanks

I practice in Springfield, a very blue-collar logging town, even though I live in Eugene, definitely the hippie town of which you spoke. Not so much "yuppie"...now that's Bend.

I've not previously heard or read of a state-by-state model. I'll think on that awhile before responding.

Thanks for your note.

by Todd Huffman, M.D. (80 articles, 0 quicklinks, 1 diaries, 109 comments) on Friday, July 6, 2007 at 2:19:44 PM
 


Don'pigeon hole me or sterotype me
pratliff94Don'pigeon hole me or sterotype me

Dr. Huffman

I agree with you. As far as a world citizen goes,  the Iraq War is more important to me; however, as an American citizen, a national health care system which works is far more important to me since I am Christian minister.  What I see on a daily basis and dealing with all those outside looking in is enough to break your heart.

I distrust States Rights. If it is decided on a state by state basis, the progressive and wealthier states will have universal health care and the last two thirds will not. When it comes to health care, I am a egalitarian and do not want this to be left to the whims of the power structures in each individual state.

I wished you would write more on what you perceive as a medical doctory and what you see happening with your peers in the medical field concerning this issue.

by pratliff94 (0 articles, 0 quicklinks, 0 diaries, 948 comments) on Saturday, July 7, 2007 at 8:12:25 AM
 


*****************************************************



Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

tabonsell*****************************************************



Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

NO STATES' RIGHTS

But, we won't leave it up to local politicians to pick and choose who would get medical coverage in HMOs just as we don't let reactionary politicians keep qualified people out of Medicaid. The HMO proposal is an extension of Medicaid made simple, and any politicians who would refuse coverage for anyone would get no coverage for himself or herself.

Think of the possibilities. People who show up for their HMO physicals could get a small rebate. People who follow doctors' instructions and maintain a healthful lifestyle could also get a small rebate when specific objectives are reached. And HMOs that are successful in keeping their clients out of hospitals could also be rewarded with rebates. The objective is to prevent unnecessary hospitalizations and treatments for diseases that could have been prevented.

by tabonsell (28 articles, 0 quicklinks, 22 diaries, 250 comments) on Saturday, July 7, 2007 at 12:35:47 PM
 


Todd Huffman is a pediatrician and writer living in Eugene, Oregon. He is a regular contributor to many newspapers and publications throughout the Pacific Northwest.
Todd Huffman, M.D.Todd Huffman is a pediatrician and writer living in Eugene, Oregon. He is a regular contributor to many newspapers and publications throughout the Pacific Northwest.

But...

But in a state-by-state system, wouldn't coverage (vis a vis funding) be subject to the individual state's economic ebbs and flows? For instance, here in Oregon, we have the Oregon Health Plan, which still provides care for qualifying children, but due to decreased funding over the past five to ten years the number of qualifying adults has dwindled, and we have one-fifth of our population now without any public or private health insurance.

Funding at the national level would be more stable, although I would put forth that given the vast differences in lifestyles and costs of living from region to region, any sort of UHC system would need to have regionalized administrative oversight boards to account for each region's unique and specific needs.

While I'm no expert at health insurance administration, mind you, my gut is that a state by state system would maintain the current levels of inequity between states in health care quality and delivery, even while providing universal coverage for each citizen within a given state (which would certainly be an improvement over what we have now...almost anything would be an improvement over what we have now).

And thanks to pratliff64 for the positive feedback. I will certainly take up your suggestion to write more on the consequences of our broken health care delivery system on our friends and neighbors, at least from my smalll window on the world.

I would also urge you and other readers to be reminded that most primary care physicians support UHC in some form, contrary to the position of the AMA, to which few primary care physicians belong. Only about 25% of physicians are AMA members, overwhelmingly specialists, who have a vested interest in maintaining the status quo. However, the American Academy of Pediatrics, the American Academy of Family Practice, and the American College of Physicians (internists) each support UHC in some form. I think that the general public impression is that physicians oppose UHC, and this is a gross misperception.

by Todd Huffman, M.D. (80 articles, 0 quicklinks, 1 diaries, 109 comments) on Saturday, July 7, 2007 at 1:30:02 PM
 


*****************************************************



Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

tabonsell*****************************************************



Thomas Bonsell is a former newspaper editor (in Oregon, New York and Colorado) United States Air Force cryptanalyst and National Security Agency intelligence agent. He became one of American journalism's leading constitutional experts through years of study at Georgetown University Graduate School of Government in Washington, D.C., and tries (without much success) to be patient with people who argue endlessly on su...

to see more of bio, click on member name

DUAL APPROACH

My state-by-state proposal would cover only a portion of the health-care system; the most-stable part not subject to wild fluctuations. The portion subject to wild fluctuations ~ hospitalization ~ would be at the national level where funding is more easily available. Now, of course, there would be a major difference in the financial needs of Opp, Alabama, and Ojai, California, but we have those differences now under Medicaid. My proposal only makes the system simpler and more easily available without messing with the tax codes, which now are way too complicated and cumbersome.

My health-care ideas are only a part of a larger picture which would encompass elimination of the income tax because it has been rendered unworkable and replacing it with a profits tax. Think Enron and other criminal companies paying taxes on their reported "profits."

No tax on a basic "living wage" would free up billions of dollars for states to tap into to fund their systems.

Profits of individuals would be taxed for health-care and Social Security. Profits on corporations would pay for the military and Homeland Security and taxes on other business would pay for the remaining government operations. Make a profit in the US, pay a tax in the US: no running off to Dubai or the Cayman Islands to escape taxation.

by tabonsell (28 articles, 0 quicklinks, 22 diaries, 250 comments) on Sunday, July 8, 2007 at 12:59:30 PM
 

 

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