Sounding Board
Let's ensure that everyone is insured
Universal health care, a Catholic physician argues, would allow doctors to get back to the art of healing. Both patients and our pocketbooks would be healthier if we Catholics fought for it this election season.
I grew up in a very impoverished part of Virginia. Most people were very poor farm laborers. Despite this, when patients came to the physician's office, the first question was "How can we help you?" not "Can I see your insurance card?" There was no copay. My dad was a physician who got paid by approximately half of his patients. The pharmacist across the street from my dad's office made similar concessions. There were no financial incentives to avoid getting medical care early in the course of a disease. Healers were ministers interested primarily in the welfare of patients, not for-profit dealers.
As a medical student in Rochester in the 1960s and a physician in Birmingham in the 1970s, I saw all patients, regardless of means, get excellent care. In the 1980s as a scoutmaster of an African American troop in one of the most impoverished areas of Cleveland, I became aware for the first time that our health care system was changing. One of my scouts had a serious injury to his knee that could have made him a permanent cripple. I became aware of his injury several weeks after it occurred. He had not seen a physician. His mother had been injured and seriously disabled as a police officer during an arrest and had numerous financial strains. She was worried that medical care might make them homeless—only in America, not in the other large, industrialized democracies.
The late Cardinal Joseph Bernardin said, "Health care is an essential safeguard of human life and dignity and there is an obligation of society to ensure that every person be able to realize this fundamental right." We should have universal health care because it is the right thing to do. It would be more economical for our country than what we are doing now, and the industrialized democracies that have provided universal health care have achieved medical results for most diseases that are generally significantly superior to the results that we have obtained.
In the Journal of the American Medical Association in 2003, a group of more than a dozen economists and physicians—including three from the Harvard Medical School faculty—concluded that a slightly modified Medicare for everyone with no copays or deductibles would provide higher quality health care than Americans received then and save at least $200 billion annually.
I strongly support a single-payer system that would let the patient choose hospitals and physicians, and that would provide medicine without charge, use quantity purchasing to save enormously on the costs for drugs, and eliminate the hundreds of insurance companies and HMOs that currently deceive patients and increase the cost of health care.
We in the United States spend more than twice as much for health care per person as the average of the world's other 10 largest industrialized democracies. Expenses related to health care have passed the loss of employment as the single most common cause of bankruptcy—only in America. As itemized by Daniel Gross in the New York Times in 2006, the U.S. government paid two thirds of the dollars spent on health care in the United States in 2005. More dollars per person are spent by the U.S. government than by the other large, industrialized democracies that pay all or most medical expenses for all of their citizens.
What do Americans get for dollars spent on health care? As documented by Rudolph Mueller, M.D. in his book As Sick as It Gets (Olin Frederick), "There is no question that there are numerous Americans who are sick who would not be if they lived in Europe, Canada, or Japan, where they would have had accessible primary and preventative care."
Recent research supported by the Commonwealth Fund found that if the U.S. health care system performed as well as those in the other industrialized democracies, we would have 101,000 fewer deaths each year. We rank at the bottom among the industrialized democracies in preventable deaths and life expectancy despite the fact that we smoke less tobacco, a habit that shortens life by seven to 10 years.
Perhaps the most formidable problem that we face in our system is the comfy feeling of those who have insurance. We have poor medical results, some think, because we have 47 million uninsured citizens and at least as many citizens who are underinsured. Let Lazarus lie at the gate of the rich man clothed in purple, and let the dogs come and lick his sores. He does not have an insurance card. Those of us with insurance cards are all OK. Right? Wrong!
Insurance companies, as well as many hospitals and clinics, encourage doctors to use "cost-effective" treatments and be "productive." Doctors are pushed not to waste time listening to patients and thinking; time is money. Seeing patients too rapidly maximizes both profits and medical errors.
Insurance companies constantly change policies about what treatments are covered. After learning that one major insurance company changed covered treatments more than 200 times in a single year, an executive of a company that is paid to recommend health insurance policies told me, "I could think that I am recommending a Cadillac, and it might be a Cadillac or a Chevrolet. It might be a Cadillac now and a bicycle when the insured person gets sick and needs to use it." As Christians, should we not insist on excellent care for everyone? Should profits be a dominant motive?
Where is our money being wasted? Harvard University researchers found that 31 cents of every dollar spent on health care is wasted on needless administration. Medicare spends less than 3 cents on the dollar for administration.
Health care providers often give three- to sevenfold discounts to insurance companies—discounts that those who cannot afford insurance do not get. Insurance companies restrict patients' choices of physicians and hospitals and alter therapeutic choices that have been made by patients and physicians, often without the patient's knowledge. Insurance administrators argue with providers, thereby increasing providers' overhead. Companies sharply raise the premiums that patients must pay to keep their insurance after they become seriously ill and disqualify as many sick customers as possible in order to maximize profits. (Do patients buy insurance to be insured only when they are healthy?) They contribute to politicians, pay lobbyists, buy advertisements, pay dividends, and increase profits to make stockholders rich.
Insurance policies and bills are unintelligible to most patients and physicians. The more than 1,500 insurance companies, most with multiple kinds of policies, and more than 300 HMOs make it necessary for health care providers to hire administrators to deal with these companies. My physician told me that he has two employees who work for him directly. One takes care of patients; the other tries to interpret insurance company policies and calls companies. This is what we buy when we pay our health insurance bills.
Another expense is medicine. A recent medical journal article details how the Veterans Administration gets a discount of almost 50 percent from retail prices from pharmaceutical companies. Some other countries get similar discounts. Why don't most of us get these discounts? Medicare D recipients save an average of less than 20 percent on drugs while the drug plans continue to raise prices at two to three times the rate of inflation.
A study in 2001 found that if insurance companies were eliminated in Vermont and the state paid all medical bills, the money spent on medical bills in 2001 would cover all citizens, including the uninsured and the underinsured, with $118 million left over. Similar studies in other states with larger populations have shown that if insurance companies were eliminated, Georgia would save an average of approximately $716 million a year; Michigan, $1.3 billion a year; California, $31 billion a year; and so on.
We in the United States are spending much more for health care per person and getting less than those in other industrialized democracies. But there are more important reasons that citizens should be concerned. The Rev. Martin Luther King believed that "of all the forms of inequality, injustice in health care is the most shocking and inhumane."
The provision of health care for all is the right thing to do. Are we our brothers' and sisters' keepers? Some think we cannot change the system. I would respond that we, as citizens, are in the best position to prove that we can change the system.
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