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Universal Healthcare Primer

By       Message Christopher Wright     Permalink

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  Can't Afford Universal Health Care? 

In a study by the Commonwealth Fund in May of 2007, the U.S. ended up 6th out of 6 industrial nations on healthcare as it has for several years running. Yet we pay twice as much per person than they do. Canada did almost as poorly as the U.S. did but at half the price. The difference: The others have universal health insurance. Complaints of long waits for medical appointments in Canada is matched by those in the U.S. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678 

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The U.S. did show excellence in the category of "Right Care" which deals with the provision and receipt of preventative care. Initially this sounds good but as the newspapers have pointed out recently, some 46 million of us mainly go to emergency rooms for medical (as the President suggested) and those are long past any use for preventative medicine.  For all this money, the World Health Organizations rates the U.S. system as 37th in world healthcare way back in 2000. http://content.healthaffairs.org/cgi/content/full/20/3/10 Wonder what it is now? 

We pride ourselves on our advanced technology but are blocked on accessing a patients entire medical history, what drugs they are on and who else is treating them primarily because we don't have a universal, accessible, efficient database.

 Because we do not have the above system for billing, the U.S. pays $1,059 per capita for administrative costs (billing, clerical, insurance) whereas in Canada it was only $307.(figures from 2003) http://content.nejm.org/cgi/content/abstract/349/8/768 The high profit of insurance companies contributes strongly to this difference. 

Specific Costs of Health Care Administration in the U.S. and Canada, 1999 – in U.S. $                                                                  U.S.                            Canada

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Insurance Overhead$259$47
Employers health mgmt costs$57$9
Hospital Administration costs$315$103
Practitioners Admin costs$324$107
Home Care Administration$42$13
http://www.pnhp.org/publications/nejmadmin.pdf 

When I lived a year in Canada, physicians told me that they had little need for billing clerks as it was almost all done with the Health Card via computer and that they almost always received payment within 30 days. They were telling me this while they were charging me only $20 (U.S.) per appointment – try finding that in the U.S. The second big problem listed is access to care which is primarily solved via the same single-payer system and we still end up saving money.

How about costs? 

Well, it's true enough that you can get the very best medical care in the world in the U.S. if you have enough money, but the same formula applies throughout the world. It is estimated that a Universal Healthcare plan for all those citizens in the U.S. without adequate health care would run about $100 billion or about 6 months of the Iraq war. http://www.nytimes.com/2007/01/17/business/17leonhardt.html?_r=1&oref=slogin 

In an interesting twist, the U.S. gave $1 billion to Iraq for the development of Universal Healthcare. http://www.thecarpetbaggerreport.com/archives/13544.html Isn't that interesting? Sure, a billion isn't much compared to the estimate for the U.S. but then again, Iraq is that much smaller a population, isn't it?  

The current situation: 

U.S. patients can't count on speedy access to care; 51% said they could not get an appointment  the same or the next day when they were sick(BusinessWeek.com, 6/22/07). Only Canada scored worse, with 64% saying they had to wait (but their emergency rooms are free for citizens). http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678  

Once in the health-care system, 32% of U.S. patients suffered medical mistakes, the highest rate of the seven nations. (Ibid) 

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U.S. patients were the only ones to report serious problems paying bills (19%). Plus, 30% of patients paid $1,000 or more out-of-pocket over the past year, while the percentage of patients laying out that much in the other six ranged from 4% (Britain) to 19% (Australia).  

Nearly two out of five U.S. adults and 42% of those with chronic illnesses skipped medications or did not see a doctor when sick because of cost. Those rates are much higher in the U.S. than in any other country. (Ibid) 

Ever-Rising Costs: 

  • Total health care spending represented 16 percent of the gross domestic product (GDP) U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 TRILLION in 2015, or 20 percent of GDP. http://www.nchc.org/facts/cost.shtml (Getting sick is an important, patriotic part of our economy? If we weren't sick, the U.S. would be poorer?)
  • In 2006, employer health insurance premiums increased by 7.7% – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $11,500. The annual premium for single coverage averaged over $4,200. Small employers saw their premiums, on average increase 8.8 percent. Firms with less than 24 workers, experienced an increase of 10.5 percent. (Ibid)
  • The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $11,500 in 2006. Workers contributed nearly $3,000, or 10 percent more than they did in 2005 (3). The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712). (Ibid)
  • Since 2000, employment-based health insurance premiums have increased 87%, compared to cumulative inflation of 18 percent and cumulative wage growth of 20 percent during the same period. (Ibid)
  • 68 percent of those who filed for bankruptcy had health insurance.
  • Retiring elderly couples will need $200,000 in savings just to pay for the most basic medical coverage. Many experts believe that this figure is conservative and that $300,000 may be a more realistic number. This, of course, is in addition to normal living expenses.

 What other factors are involved in increasing health care costs? 

From the citizens point of view: 

With costs increasing around 10% a year but incomes stagnant or fixed for an ever- increasing portion of the citizenry, a two-tiered system of healthcare becomes unavoidable. Capitalism and citizen health are necessarily at odds with each other. Insurance companies are some of the richest corporations in America and will not give up their largesse easily and plainly, a universal, single payer system doesn't need them. 

As it is, under the present system, Americans don't have as long a life expectancy as most industrial countries and less than all the main ones with universal health care. Our infant mortality is also one of the highest in that same group.  

When you hear about the number of uninsured in America, you really don't get the full picture. While the number itself is an aggregate, people come and go off the list. In reality, 1 in 3 Americans under 65 was without health care coverage at some point in 2006 and 2007. http://www.nytimes.com/2007/11/09/opinion/09krugman.html?em&ex=1194843600&en=8c51fe91bab83806&ei=5087%0A

Even those over 65, those with Medicare, are effectively without coverage when the costs rise much higher than the available income can cover Medical care and medicines are simply done without. At the same time, the number of physicians who will see Medicare patients, considering the small amount that Medicare pays for those services and the time it takes to actually collect even that amount, is shrinking rapidly. (Anchorage Alaska has zero private providers that accept or will even keep Medicare clients for all of South Central Alaska). That means that our elderly have to drive farther, search harder and wait longer than mostly anybody – and they have insurance! 

If everybody has the same single-payer program, it eliminates wildly varying charges by different physicians/clinics/pharmacies, allows for bulk price negotiation and guarantees access to everybody. Private insurance would still be available for those who can afford it and desire what extra benefits it can give but it should only cover costs over and above the federal price for the procedure to avoid two competing systems. 

There has been some hullabaloo recently that some of the uninsured make over $50K a year. That sounds like they should be able to afford health insurance, right? Well, in the first place, only 63% of employed workers in the country actually get employer contributed health insurance http://blog.healdeal.com/?p=16 

Think about it with the numbers noted around this paper. $50K a year minus about 25% for various standard taxes (Fed, State, local, property) equals $37.5K. Assume they are living with a mortgage and associate costs, the average of which is, in the U.S. was $14,240/yr in 2005 http://www.tml.org/leg_updates/legis_update083107a_payment.html, brings them down to $23,260 in available income. If it is a family of 4, parents and 2 children, average utility costs (heading, electricity, sewage) will eat up $3K and food will be around $10.5K http://www.cnpp.usda.gov/Publications/FoodPlans/2007/CostofFoodOct07.pdf bringing discretionary income down to $9,760. 

Drop in a few co-pay's, some OTC medications, a car payment, occasional clothing for a growing family, gasoline costs, maybe some winter tires, heat would be nice to have and absolutely no entertainment that costs anything and you tell me where the $11,500 in insurance premium will come from? By the way, the $11.5K is an 'average rate' for employers with 'group' plans, not the price a single family would get. It does seem that the folks making hundreds of thousands think that for the rest of us, even $50K is almost too much.

 Does anybody wonder why John Edwards gets standing ovations when he threatens to remove the health benefits for Congress if they won't provide healthcare for all U.S. citizens? Or why Dennis Kucinich's followers are so loyal (he has been for a single payer, universal health care for years and years).  Sure, lots of other contenders are jumping on the bandwagon but how many of them have a serious plan and how many of them can show a history of following through.

 If you are expecting help from the leading 3 Democrat contenders, give it up! All three are modeling their health plans on existing State plans that haven't worked at all, have busted budgets (in billions) by selling their programs with low-ball figures and include 'mandated' insurance with accompanying costs, restrictions and penalties.  For example, in the Massachusetts plan, only 4% of the 244,000 uninsured have joined the program. The insurance companies still control the cost of policies and the scope of services provided so different folks get different plans. http://www.accuracy.org/newsrelease.php?articleId=1594 This is not universal health care but universally mandated healthcare. 

The numbers in this paper are big – both in people, in dollar expenditures and in human pain and suffering. We need a president and a congress that will return their focus on the United States. 

My suggestion is to forget about all party lines. Vote in a rainbow of candidates –liberals, conservatives, green, libertarian, independent and more - so no one has a majority and everybody has some one looking over their shoulders – and everybody has to be responsible or be called on it! If you are voting partially on the healthcare issue, make sure there is a realistic and practical plan rather than just a vote-getting strategy.

 

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Christopher is a retired Mayflower family, Navy Vet, flower child, Mensan and a long-time rural Alaskan with a lifetime or two in Social Sciences and cross-cultural endeavors. He has a terminal graduate degree and is heading into his terminal years (more...)
 

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