The Only Good Option For Health Care is a Public Opiton

The United States has the most expensive, least efficient and, in many ways, most ineffective healthcare system in the world. But you wouldn't know it if you listened to Republicans talk about the private health care insurance system or Democratic Blue Dogs whine about costs of reform and complain about how unfair it would be to have private health insurance companies compete with a public health care option.

Despite being the most expensive health care system in the world, in terms of medical outcomes, the private U.S. health care system is the most ineffective. In fact, the World Health Organization ranks health care systems based on objective measures of medical outcomes and the United States' health care system currently ranks 37th in the world, behind Colombia and Portugal [which both spend far less on health care than the U.S. The United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. While infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth.

Not only are 47 million Americans uninsured (approximately 18.5 percent of the insurable market), 41 percent of Americans with incomes of $20,000 to $40,000 did not have health insurance for at least part of 2007, up from 28 percent in 2001; 53 percent with incomes under $20,000 lack health insurance.

There are additional costs to the haphazard U.S. health care system: More than 50 percent of the U.S. population has medical debt problems; between 1981 and 2001, medical-related bankruptcies increased an astounding 2,200 percent and 55 percent of personal bankruptcies are now caused by illness or medical debts, despite the fact that over 75 percent of the bankrupts had health insurance at the onset of bankruptcy and illness.

Contrary to popular conceptions, the average medical bankrupt was a 41-year old woman with children, some college education; over half owned homes and over 80 percent were in the middle or working classes.

The number of people without health insurance rose 18 percent from 2001 to 2007; average health insurance premiums for a family of four are more than $13,000, which exceeds the annual gross income of a full-time, minimum-wage worker. Lack of insurance causes 18,000 excess deaths a year; people without health insurance have 25 percent higher mortality rates; and, 59 percent of uninsured people with chronic conditions such as asthma or diabetes skip medicine or go without care -- and get sicker.

Out of 30 developed nations, life expectancy in the United States ranks 21st: Life expectancy in the United States is 4.6 years less than Japan, 2.1 years less than France and 2.6 years less than Canada. The United States has fewer physicians, nurses and hospital beds than most developed nations. In the United States, 28 percent say it is "difficult to get care"; in most European countries, Japan, Australia and New Zealand, 15 percent say that. In terms of continuity of care (i.e., five-plus years with the same doctor), the United States is the worst of all developed nations.

By every objective measure, the United States has a second-rate health care system.

The Truth About Healthcare Costs

Even including the 47 million uninsured, the bloated, inefficient U.S. healthcare system costs more than double per capita what single-payer healthcare systems in Europe, Japan and Canada cost.

In the United States, healthcare costs were $6,001 per person in 2007. By contrast, in Japan, with life expectancy 4.6 years more than the United States (presumably a cost-increasing factor), healthcare costs were $2,139 per person; in the United Kingdom, $2,232; Sweden (the ultimate "welfare state"), $2,520; France, $2,903; and, Canada, $3,001.

And, this is not just an individual problem; this is a national problem. Health care system costs in the United States are 17 percent of GNP (and currently increasing 12 percent per year). No other country in the world has healthcare costs which exceed 11 percent of GNP and the average among developed nations is 9 percent. These high costs are making the U.S. uncompetitive in many areas. For example, U.S. car-makers spend $1,500 per car on health care---more than the cost of the steel in cars -- and are competing against European and Japanese car makers who spend nothing for health care.

Administrative costs of the U.S. private health care system consume $300 billion; profits and advertising consume another $300 billion [the CEO of Cigma insurance company made $23 million last year]. Compare those numbers to the $100 billion Republicans and Democratic Blue Dogs complain is too high a cost to reform the system and deliver care to 47 million uninsured. And compare the high overhead costs of the private health care insurance system to the 3 percent overhead of Medicare and single-payer health care systems in Europe, Canada and Japan.

Two years ago, one of my adult sons went to a medical office for testing. On completing the tests, he was handed a bill. The bill had two prices: One was the insurance price, $969.25, the second was the "cash pay price," $678.00 -- exactly 30 percent less than the insurance price. What more do you need to know about the excessive cost and inefficiency of the American private health insurance system than that it costs 30 percent more than the underlying medical services are worth?

This is the costly, inefficient system -- and the profits -- that Republicans and Democratic Blue Dogs [bought off by health insurance money] are seeking to protect.

In America's for-profit private insurance health care system, medical technicians must contend with hundreds of different forms, billing procedures, regulations and requirements from hundreds of insurance companies; U.S. health care companies spend money for advertising and marketing; and, the U.S. health care system is based on profit. Since 1970, the number of medical doctors in the United States has increased 40 percent, while the number of medical administrators has increased almost 3,000 percent.

Currently, we are drowning in a massive, inefficient private health insurance bureaucracy. The increasing cost of prescription drugs also is increasing the health care bill, and U.S. drug costs are the highest in the world. Americans pay 30 percent to 80 percent more for prescription drugs than citizens of any other country largely because Republican legislation enacted under George W. Bush prohibits Medicare and private insurance companies from negotiating lower drug prices from Canadian and European suppliers, even of American pharmaceuticals. So American patients pay double and triple the cost of the same drugs, in the same bottles, made by the same companies in the same plants as Canadian patients. Profit in the present U.S. system has been exalted over good care, health and cost considerations.

You might think that this excess money goes into developing new drugs, but you would be wrong: Only 13 percent of drug costs go to research and development, and little of that goes for pioneering new drugs to deal with life-threatening conditions; 51 percent goes to marketing, administration and profits.

And when considering costs of health care, remember that the U.S. taxpayer already pays for more than 60 percent of the American health care bill. It does this by allowing businesses to deduct the cost of health care for employees as a business expense, thus reducing taxes on businesses, which puts a greater burden on individual taxpayers, as well as paying for government supported health care such as Medicare and the Veteran's Administration health programs. Being the payer of 60+ percent of existing health care costs, you would think the U.S. government would have a right to demand a more efficient system [President Obama thinks it does], but not if you listen to Republicans and Democratic Blue Dogs complain about change [i.e., less profits for their insurance company donors].

The Public Option

The most logical correction to the costly inefficiencies of the American private health insurance system would be a single-payer system -- such as Medicare, a popular and successful single-payer system. But single-payer has proven to be too radical a change for Congress even to consider this time around, so we are left with the possibility of a "public option," which would allow individuals and employer plans to buy into a public system modeled on Medicare. While this "public option" may not be the perfect solution, the perfect should not be the enemy of the good. Moreover, if the public option is robust, over time it would out-compete the costly, inefficient private health insurance system and you would find not only individuals choosing the public option, but also employer health plans concerned about costs. And precisely because the private insurance companies fear competition from a more efficient public health care system, it is using every weapon in its arsenal to spread fears of "a government takeover" of health care, distort the debate and, of course, buy off members of Congress [Republican and Democratic Blue Dog members of the Senate Finance Committee, for example, have received an average of more than $2 million each in donations from private health insurers].

While single-payer will not be legislated this time, what would be unacceptable would be for health care legislation not to include a robust public option, or to so weaken the public option that it could not compete effectively with private insurers, such as prohibiting use of Medicare rates for medical services, prohibiting negotiation with drug companies for lower prices and/or breaking up the public plan into regional, state or local "coops" which would be too small to compete against national insurance companies. This is the current fault-line in Congress and is why the public option is being attacked by conservatives as "socialized medicine." Of course, neither the public option or even single-payer systems are socialized medicine.

Medicare is a single-payer system and single-payer systems such as Medicare do not employ any doctors or own any hospitals or medical facilities, let alone create bureaucracies like the bloated, inefficient bureaucracy the private insurance model has created in America. The Veterans Administration health system is a socialized system, as is the military health system, as they both employ doctors and provide hospital facilities, but ironically none of the opponents of the public option ever mention the VA system or the military.

Rather than hundreds of payers (insurance companies) and thousands of different forms, regulations and procedures, a public option would have one payer and one set of forms and procedures. A public health care option, like Medicare, also would offer more choice of medical providers; unlike the current private insurance system, where patients are limited to panels of providers, a public plan would permit patients go to any doctor they want, submit a national health insurance card and the government would pay -- just like Medicare. It is the simplest, most efficient plan of all.

There are many ironies in the debate about the need for a public option and one of them is that in one breath conservatives argue that the government is inherently inefficient and can't run anything, and in the next breath argue that it would be fundamentally unfair to make private insurance companies compete against a public health care plan. Of course, the truth is that the inefficient private system probably can't compete effectively, but why should we protect inefficiency in health care? We don't run police and fire services privately or the Army, Navy and Air Force, so why should private for-profit insurance companies hold a virtual monopoly on health care, especially when the evidence is overwhelming that they don't do a very good job at it?

Congress will be in summer recess next week. This is the time your Congress member and Senators need to hear loudly, clearly and repeatedly by email, phone and letters that you support a robust public health care option, one modeled on Medicare.

Guy T. Saperstein is the Co-Founder of the New Ideas Fund and past president of the Sierra Club Foundation; previously, he was one of the National Law Journal's "100 Most Influential Lawyers in America."

Comments

[bmull]

Meanwhile, yet another person hates unions and thinks the public option will lead to thousands more unionized government workers. (1) By almost any objective measure, unions are good for working families. (2) "Thousands" of civil servants administering a public option with tens of millions of enrollees would equal incredibly low overhead by private sector standards. (3) The argument that it will bankrupt private companies is true. It will bankrupt bloated monopolies and reform others into more efficient systems. That's one of the main objectives of health care reform. Tell me how we get there without a public option. You would prefer even more regulation perhaps?

Finally someone thinks Democrats will provide free health care to illegal immigrants. Never mind that there's a good argument to be made that we should since we in effect pay for them already. Obama has explicitly said he will not accept such a bill.

[bmull]

Saperstein gives a nice statistical argument for the public option. It's not perfect--the anecdote about his son is particularly flawed. But, in a microcosm of the national debate, none of the commenters debate him on the merits:

One person is against reform because he despises everything about France. (I'm not kidding--see for yourself.)

Another person points out that Social Security and Medicare are running out of money, but fails to explain WHY they're running out. (Bear in mind this is no secret. Anyone with a casual knowledge of the issues understands these things.) The fact is Congress did not set aside enough money and in fact used the trust funds for dubious general expenditures.

The same person says that the Veterans Administration has been guilty of providing veterans with substandard care. I'll grant you VA health care could be a lot better. But it's not in any way "substandard" if you consider the standard to be what the average person gets. What I get is doctors who don't communicate with each other. I'm shuffled from procedure to procedure, none of which I really understand, though I get the distinct feeling someone else benefits more than I do. In the end I have to battle my insurance company over the bill, and usually I end up paying more than I bargained for.

[Billl]

Delivering all government funded health care through government owned hospitals and clinics, operated by government employed doctors and care providers would save hundreds of billions of dollars annually.

A dual, public/private system, offering dual choices for everyone to select, either free public care, or unlimited choice private pay private care, could serve every need and interest.

Independent private health care should be unfettered by government mandates.

Going back and forth between free public care, paid for by a national sales tax, and user purchased private care, may suit some people, and it would provide unlimited choices, ultimate freedom, and always free public care would be available when it is needed or desired to everyone who asks for it, no restrictions period.

Businesses large and small choosing the public care option could also free themselves from all financial burdens, or any involvement in any way for the health services their employees receive.

Best Care Anywhere, Why VA Health Care Is Better Than Yours, written by Phillip Longman should be required reading for President Obama and every legislator.

[DougDeWitt]

An interesting read. With all due respect to Mr. Saperstein (I applaud his record in upholding the rights of the "little guy" over a distinguished career!), the numbers he cites have no original source references (it's why God created the hyperlink!) It is unfortunate reality (and pardon the levity) that 87% of all statistics used in any given argument are made up on the spot.

At any rate, I note the claim that health care in the US cost each person (voter? or each man, woman, and infant child?) $6K in 2007. Assuming this is inclusive of every conceivable medical bill, including eye care, dental, mental health, etc, were we to apply this to the 2.59-member average American family, it would take $15,540 per family to cover the entire cost of health care here in the US, with zero deductible, zero co-payments, and all-inclusive coverage with far less waiting than the single-payer systems can offer.

We are all in this together, everyone agrees. We want everyone covered, for everything, with no out of pocket expenses for anyone (mostly because the poor HAVE no money in their pockets!). We simply need a way to pay for it all.

Follow more here: http://whigsntories.blogspot.com/2009/08/short-primer-in-health-care.html

[BillBetzen]

Sadly the current demonstrations against the health care reforms are an indication of the educational level in our nation. It shows what decades of having one of the highest dropout levels of any industrialized nation will do for you. The quality needed in education to help people think analytically and critically is gone from the US educational system. People can only remember a catch phrase and simply repeat it. They are unable to listen and respond logically to what is said. Thus yelling matches are being seen all over the US. There will not be an easy end to this crisis unless more people willing to listen and respond to what is said in a polite and logical manner are willing to attend these public meetings.

We need health care reform! We need people willing to quietly speak and then also listen to attend these meetings. I sometimes think the sign to be carried at these meetings is "May I speak now, or are you threatened by health care logic?" The other side of the sign could have two lists of highest and lowest items. Under highest could be: health care costs, infant mortality, bankruptcy rates due to medical expense. Under lowest could be: percentage of population insured and life expectancy.

[DougDeWitt]

Unfortunately, the public school system in the US was designed to train factory production units to be good in their roles, NOT to teach them to think critically, or that independent thought is the foundation of reasoned decision-making.

My daughter graduated valedictorian of her high-school class. The presentation of an award was deferred to a private meeting in the principal's office, so as not make any of the less-gifted graduates feel inferior. The crowning moment came when three students in a class of over 300 were honored for Perfect On-Time Attendance.

Of course. The most important asset for a production unit destined to make someone a profit for the next 40 years of his life is perfect on-time attendance. Followed closely by follow all the rules. And follow company policies and procedures at all times. Think inside the box. Avoid independent thought. Don't disrupt the flow of production. Corporate profits supersede the individual. Etc, etc, etc ad nauseum.

[sino53]

Mr. Saperstein:

Thank you! You have virtually confirmed that the purpose of the public option is to be sufficiently "robust" that it destroys the private insurance market and leaves us with a single-payer system just like France. (And I despise everything about France.)

We're going to quote you to Gibbs, or Pelosi, or any of Obama's supporters, the next time they try to deny that ObamaCare is a plan for single-payer.

You lefties are in a real jam here: You want single-payer, you want ObamaCare to move us to single-payer--while at the same time you keep trying to reassure Americans that ObamaCare isn't "really" single-payer!

Your duplicitousness is visible to all in America. That's why you're losing this fight.

[Georgebailey222]

According to the THE 2009 ANNUAL SOCIAL SECURITY AND MEDICARE TRUST FUND REPORTS,
both Social Security and Medicare are running out of money.
http://www.ssa.gov/OACT/TRSUM/index.html
For years the Veterans Administration has been guilty of providing our veterans with substandard care.
Why should we trust the government to run a public option or government run option health care when they cannot manage the health care programs they are already responsible for? I think that is my biffest problem , is that the government over many many years has proven that it is neither the best, nor the most cost efficient at ANYTHING.

I

[unclejeff]

And why would the private companies go bankrupt, then?

Could it be that they are already fleecing people with outlandish premiums, high copays and coverage denials--- and when faced with a simple affordable public option, nobody would choose to stay with private insurance under its current terms?

If the private system today is really 'the greatest system in the world" then give us crazy Socialists our Public Option, evil government "union" employees (reality check, in my state less than half of government employees are union, I worked there and wasn't) and and the lines, and let the haves bask in and enjoy their glorious insurance coverage and first-rate service.

I'd sure rather wait in line to see a real doctor than use duct tape and superglue and bite down on a whisky cap, which is what I'm forced to do now.

[qazwsx9999]

- public option in health care
- private companies are bankrupt
- Government health care department is run by thousands of union employees.
- Doctors sick of government involvement, form union too
- union army grows and our taxes are sucked dry.
- Unions are on strike!
- End of America
-Smith

[unclejeff]

The same arguments these people are making to sink Public healthcare as socialism, etc., are the ones that were used to try to destroy Social Security when it was proposed- THE ONLY Federal Government program currently in existence, that actually makes more money than it costs to run------- and would be solvent virtually indefinitely if the politicians didn't raid the treasury and left it alone. And without Social Security, aka 'evil Socialism' millions of eldely Americans would be suffering right now today, in poverty.

I hope Americans wake up and demand the Public Option- demand REAL CHANGE while there is still time, not short term Insurance company 'bailouts' and subsidies--- before you and I get an illness and lose everything we have worked for.

[unclejeff]

It is absolutely REPREHENSIBLE to watch Republicans and Blue Dogs going on CNN live and lying to the American public, denouncing the Public Option as "ridiculous" and "big government intervention".
Anyone who can do simple math, can plainly see that having an additional choice (not to mention, the option of getting healthcare coverage that is non-for-profit) does nothing but benefit the public at large. Those who can't get insurance, will be able to find cheap bare bones coverage to keep their families alive without bankruptcy, and those who already have great insurance with private companies, will see their premiums drop to compete with it. Because what insurance company in the world willingly lowers the rates it charges you, without having to due to competition?

Also, what in the world will keep prices down if big insurance were supplemented by government bailout money, and everyone were forced by law to buy their policies? That is straight pandering to the powerful and their short term monetary gains will bankrupt our country in the end.

The only people who stand to lose from a public option, are the insurance companies and players who are lining their pockets with the current system, which basically feeds off of peoples illnesses like vultures (regardless of whether or not they are cured, and sometimes, they make more money if people aren't).

[hsr0601]

-Scare tactics from verbal to physical-

1. 'Takeover and Rationing Cliche' lost ground, as this spoiled menu did the opposite for too long.

Like freedom of press, Public Well-being as a right, a nation took root in every free nation as a natural part of life.
The debate about it is most likely to puzzle people all around the free states. And with so many people uninsured
or underinsured, the humanitarian foreign aid ahead will confuse them, too.

2. Arbitrary Market Theory, Not Fair Market Theory, should not apply to a fundamental human right.

This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.

Basically, as demand diminish, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging from finance to mental health, alongside the peak fuel price and fast-growing mortgage rate, as all of
us know.

3. The Deficit-sensitive groups have a distinctive common ground, they all have a deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they come up with a legitimate plan.

[hsr0601]

1. 'Takeover and Rationing Cliche' lost ground, as this spoiled menu did the opposite for too long.

Like freedom of press, Public Well-being as a right, a nation took root in every free nation as a natural part of life.
The debate about it is most likely to puzzle people all around the free states. And with so many people uninsured
or underinsured, the humanitarian foreign aid ahead will confuse them, too.

2. Arbitrary Market Theory, Not Fair Market Theory, should not apply to a fundamental human right.

This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.

Basically, as demand diminish, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging from finance to mental health, alongside peak fuel price and fast-growing mortgage rate, as all of
us know.

3. The Deficit-sensitive groups have a distinctive common ground, they all have a deficit-driven background out of
question.

[Matt Hendry]

America should look at the Australian heathcare system once again .

Hilary Clinton visited Australia when her husband was president to specifically see how Australia ran its healthcare system .going to the doctor in Australia is very easy and many of them bulk bill the government heathcare system and recently kevin Rudd the Australian Prime Minister announced that they are going to also reform the heathcare system and one of the big announcements was the inclusion of dental care .

I also had a small private insurance package that seemed to focus on prevention and gave me access to alternative medicine and gym membership as well as some money back on sporting equipment so the Insurance companies can still survive but they will need to offer better packages than they already do .

I live in the US now and heath insurance is one the biggest monthly expenses next to rent .

[StartLoving]

More a fight more for the SOUL rather than the body of America is this Healthcare battle. Will we arise from mere sheeplehood, and take this country back from the Corps? It is now, or never.