Health Care for All

Our health care system is deteriorating. There are now 47 million people who have no health insurance, 8 million more than when President Bush took office. Millions more are uninsured. Costs are soaring. The result is not only widespread human tragedy but major economic problems.

What's more, at a time when we are not producing the numbers of doctors, nurses, and dentists needed, 56 million Americans -- whether or not they have insurance -- lack access to the most basic primary health care services. In some parts of the country life expectancy is even declining, while some 22,000 of our citizens needlessly die every year because they lack health insurance. Meanwhile, we spend twice as much per capita on health care as any other country. As a result of the greed, waste, fraud and bureaucracy in our current system, the United States now spends $2.3 trillion a year, or 16 percent of the gross domestic product, on health care. That amounts to an unsustainable $7,600 for every man, woman, and child.

What do we get for all this spending? According to the World Health Organization, the United States ranks 37th in terms of health system performance and 72nd in overall population health. Moreover, a recent international survey found the U.S. is dead last in terms of patient satisfaction.

In the long term, we need to have the courage to take on the insurance companies, drug companies, and other powerful and well-funded special interests which make billions of dollars off of human illness. Simply stated, we need to move toward a national health care program that guarantees health care to all as a right, not a privilege. When we do that, and end the greed and profiteering in the current system, studies show that we can provide quality care for all Americans without spending a nickel more than we currently spend.

While more and more Americans and health care practitioners continue to fight for the establishment of a national health care program, there are also short-term actions Congress can take that would radically improve health care opportunities for tens of millions of Americans and make the current system far more cost effective.

For a relatively small amount of money, we can provide primary health care to every American in need of it through an expansion of the successful Federally Qualified Health Center program. On a budget of only $2 billion a year, this program, which has enjoyed widespread bipartisan support, now provides primary health care, dental care, mental health counseling, and low-cost prescription drugs to 17 million people through 1,100 health center organizations in every region of the country for an average cost of $125 per patient per year. The doors of these centers are open to all, including patients with Medicaid, Medicare, private insurance, or no insurance at all, with sliding-scale fees.

Today, another 800 community health centers already have been approved but have not been funded because of inadequate resources. The simple and very important truth is that, if we fund these 800 already-approved centers and an additional 2,900 centers over the next five years, we could provide primary health care to every American in need of it. In other words, for a total of $8.3 billion a year, we could have 4,800 centers caring for 56 million people in every medically-underserved region of the country.

This upfront investment -- which constitutes less than 0.5 percent of overall U.S. spending on health care -- would more than pay for itself. The centers are among the most cost efficient federal programs in existence today. On average, medical expenses at health centers are 41 percent lower than in other health care settings.

Most importantly, from a financial point of view, by treating people when they should be treated, we can save billions by keeping patients away from emergency rooms and expensive hospitalizations. In fact, community health centers are estimated to cut the United States' health care spending by between $10 billion and $18 billion annually through reduced emergency and specialty care. It's not often that we are presented such a win-win situation - a program that meets critical needs while reducing overall health care expenditures by more than it costs.

Hand in hand with expanding health centers, we also must train the next generation of primary care providers needed to staff them. Already, fewer and fewer students are going into primary care professions, and this trend is only worsening at a time when we need them most. That is why a major investment in the National Health Service Corps and other health profession education programs is necessary in order to restore the supply of primary care providers.

At a time when the middle class is in rapid decline, the United States must guarantee health care for all. A major expansion of the community health care program would be an important step forward in that direction.

Senator Sanders is a member of the Senate health committee.

Comments

[Pyott]

There's a crucial concept about the healthcare debate some people really seem to be missing: What might possibly lead anyone to believe that 46M uninsured + 25M underinsured DOESN'T represent de facto rationing? It doesn't take a Ph.D. in economics to understand. To suggest the current system doesn't already involve considerable rationing is either naive or disingenuous.

If conservatives genuinely want to substantiate their claims universal healthcare would deleteriously impact the healthcare system, they should demonstrate it would ration healthcare for significantly GREATER NUMBERS than are ALREADY being excluded from the system. (The just-released Commonwealth Fund"s healthcare scorecard identifies 42% of adults, aged 19-64, as uninsured/underinsured.)

Universal healthcare opponents conveniently neglect another particularly glaring aspect of the debate. The U.S. lags seriously behind other industrialized countries in providing effective healthcare. Were the U.S. to perform as well as any of the top three industrialized countries, 101,000 fewer deaths per year would result. ["Health Affairs" - Jan./Feb. 2008]

More damningly -- for conservatives' arguments -- in 2005, the U.S. spent more than any other country on healthcare: $6,697 per capita (16% of GDP). Most other industrialized countries spent less than half of that ($3,128 in Australia ¦ 9.5%; $3,326 in Canada: 9.8%...).

So, not only are (1) 42% of U.S. adults getting no or little healthcare, but (2) the U.S. spends twice what other industrialized countries spend, and yet (3) places last of 19 in preventing considerable numbers of deaths.

[Liberoservative]

Okay... I waited a day.. and my points are not disputed by Mav....

so, I guess they are all valid and he was just spouting off Repub talking points....

Are you ready for Round 2?????

Gramm just resigned.... the same Phil Gramm whose wife was Enron's CFO and who authored the Enron loophole... that led to our 4 dollar gasoline... who deregulated the mortgage banks and led to the total collapse of one bank that we know of and many others that the feds have had to bolster.... who is VP on a Swiss Bank... UBS that shelters rich American's money so they don't have to pay their fair share of taxes....
That Phil... who is writing McC's Economic policies.....

Oh yah... and I am not WHINING!

[NL207]

"... a national health care program that guarantees health care to all as a right"

Such a thing is a simlpe impossibility. It does not exist anywhere in the world. In every single system there are persons who die prematurely because they cannot get the care they need, regardless of how well intentioned theat system might be.

The obvious truth: There are insufficient health care services to meet the demand for them. This is a fact of life world-wide. Simply put, in any socialized medical system, some services will be unavailable to some clients at their time of need. This is an unavoidable consequence of limited supply vs unlimited demand.

The difference between what hapens here in the US vs what happens in socialized systems is this: The people selected to be denied service are chosen at random in the socialized systems, excepting of course, the wealthy and powerful who are able to avoid these systems altogether. The people denied service in the US are the working poor, people who do not earn enough to buy into the services themselves but are also not poor enough to qualify for government intervention.

The government can spend all it wants in a vain effort to provide care for all. Unless it can somehow create qualified health care professionals and prevent people from using services they don't really need, someone will still be denied care, just like people are still denied timely care via waiting lists in Canada.

[Pyott]

There's no denying rationing takes place in virtually any economic system we know of. Healthcare is no exception. But whether rationing takes place or not isn't really in question here. What IS in question is the underlying MECHANISM we use to ration healthcare and how this affects how it is distributed across the population.

You see, one cannot argue healthcare is just like any other package of goods and services. A person's relative access to most of the goods and services available today won't negatively affect their health or lifespan, the vast majority of the time (at least not directly). Our access to healthcare, on the other hand, is one of the prime direct DETERMINANTS of health and lifespan.

One of the current system's major drawbacks is that the uninsured don't receive regular healthcare, resulting in considerably greater numbers of medical crises, which are more expensive, more lethal, and generate more complications (e.g., uninsured patients are twice as likely to visit emergency rooms). Not only is this inherently inefficient, it is also incredibly inequitable and inhumane.

There"s plenty of evidence from other countries to suggest intelligently designed universal healthcare would achieve better overall results -- on a more consistent and uniform basis -- than our current system. And it is precisely because the U.S. healthcare system generally performs so POORLY compared to other countries, at twice the cost but covering a smaller percentage of the population, that universal healthcare appears so compelling.

[Pyott]

The lack of political momentum towards the institution of some form of universal healthcare system in this country is deplorable. Moreover, it's laughable some of the most traditionally obstructive segments of U.S. society (e.g., libertarians/conservatives) actually BELIEVE one can have genuine equality of opportunity without some form of universal healthcare. They're delusional.

Like virtually every known human-made complex system ever conceived, a well-maintained system is invariably SUPERIOR to a system with major structural flaws, weaknesses, and regions of degeneration, which ultimately need to be repaired -- using more time and resources than would originally have been necessary. Healthcare is no different in this respect, and to deny preventive and therapeutic care to such a large part of the population only ends up being counterproductive in the long run.

The situation wouldn't be so frustrating if countless medical/health studies in recent years hadn't so clearly illustrated the need to establish a solid and universal BASELINE of preventive healthcare as the best means to address both the serious economic failings of the current system -- as well as the moral ones.

[wild1a]

There is a misconception of what a single payer health care system means. First, the doctors do not work for the government, they are in private practice. An example is Medicare which should be expanded to include the whole country. Medicare is the government provided health insurance program which covers all over 65. Patients go to the doctor of their choice. 80% of the medical fees are paid for by Medicare from premiums received from the subscribers. Everyone, regardless of whether or not he or she has a pre-existing condition, can sign up with Medicare. Unlike private insurance companies Medicare is not a profit making organization. Their only function is to reimburse doctors and medical facilities for treatment. Conversely, private health insurance companies are profit making businesses. Thus they are often reluctant to reimburse medical claims since it reduces the amount of capital from premiums that they can invest to make profits. Adequate medical coverage for all can never be possible from private insurers since paying insurance claims and making maximum profits are conflicting goals.

[mommamia526]

CEO-paperpushers decide on what procedure is allowed and not allowed, the insurance jumbled mess is a headache and takes up precious time that should be used treating patients. Under the capitalist method there is no bargaining power for doctors and patients, unlike for example with Medicare as we have just seen this week, to reverse decisions. Everyone is allowed and must pay, exhorbitant fees, but only CEO's, who are not doctors, decide. Basta! No talkback! This makes doctors de facto employees of insurers. This is about insurance and treatment. Then there is Medical Malpractice Insurance. This stiffles innovation and progress. Making money is not what doctors go into Medicine for in the first place, they want to help people. They also like to learn and apply new things, and that is not possible. If money was their goal there are much more lucrative avenues, such medical appliance manufacturing and sales,CEO positions at pharma and HMO's. There has also been a limit on who would and who would not attend Medical School in the U.S., with very qualified applicants rejected in favor of others, because of demographics and other reasons. Pharmacists used to be independent entrepreneurs, now they are employees of JC Penney and Walmart. Under capitalism we are getting more and more to the same configuration for doctors. That takes away from status and professionalism, among all the other drawbacks.

[emerywood]

" We are not producing the number of doctors, nurses and dentists needed " ------ a single payer healthcare system would not necessarily help in this regard. Canadian doctors came down to this country in droves for higher pay and better working conditions for years until recently. Physicians and nurses are not all altruistic and prefer to work in a single payer system automatically. There must be a reason why health care is an attractive field and a single payer system is enticing to future physicians and nurses.
Othewise, we might end up with a single payer system with fewer and fewer medical professionals and incresing patient load.

[indypete]

I'm not sure "money grubbing" is a quality I'd look for in a doctor.

[KHAAANNN]

I have never been able to understand why American Business does not DEMAND a Single-Payer Health Care System in the USA.
The only reason most American businesses are hurting is HEALTH CARE COSTS. Productivity is high, profits are good, only HEALTH CARE is out of control.
GM would be doing OK if they were not paying through the nose for Health Care for their employees. (This is why they moved so much manufacturing to Canada in the first place.)
I guess it is because in the Corporate Offices; Ideology trumps good business sense.
Did you know that in the Insurance Industry 6 out of 10 workers only exist to DENY claims and move the costs to someone else? Why do we pay so much money to someone who has a HUGE financial incentive to NOT PAY MY CLAIM!
It's insanity.

[indypete]

Biz can demand all it likes but as long as the insurance companies, the for-profit hospitals, and the drug companies pay the biggest bribes.... excuse me, campaign contributions, things won't change.

[zann]

http://www.HealthCare_now.org is a long time organization supporting single payer health care. Check it out. It is supported by unions, nurses, many others. House bill 676 (nothing like a powerful, memorable name) has 90 cosponsors, and would create a single payer health system in America. The majority of people want it. The majority in congress don't. In what way is this government by and for the people?

How does the Insurance industry fight back, (other than lobbyists and contributions)? There is AARP's DividedWeFail project, which seems to advocate either Obama's or McCains weak health care reforms. There's another, new well-funded organization, Health Care for America Now, which proposes a hybrid of insurance companies and public health insurance pools.

If you want single payer, don't be distracted by these other organizations. Too much money would be diverted to private profit.

The health care centers sound like a good idea, but I don't know how they fit in to the larger scheme. Its all to confusing. I'm sticking to HealthCare_now and HR 676. The only benefit there will apply to everybody.

[Raymondf]

Works very good if you can wait 3 months to see a doctor or 6 to 8 months for a hospital bed.

[bgregs]

Doooode! Did you even READ the darn thing!?

[schoolmaster]

2.3 trillion dollars an year. If the government cuts off all funds for health care fo 31/2 years they can pay off all foreign debt of 9 trillion dollars, gain that much time to rethink and revamp health care plan affecting a complete overhaul covering all people at much lesser cost. There will be humongous sacrifice by the people, by the doctors hospitals and other health care personnel for that long. I know I will attract bricks and stones for my suggestion.

[bgregs]

And in the meantime more than a million people will die for no reason!! Great idea!

[likeicare]

There you go again, Mr. S. -- making sense.

Can we clone you?

[mamacat]

Thank you Sen. Sanders!

I had to be hospitalised in Europe, saw doctors, got medicine and food, slept in a bed, and all I had to pay was a small co-pay.

I have talked to other Americans who have had to seek emergency care in Europe, and the result has been very good care at a very low cost, even for us foreigners.

Something can be done, and should be done. I for one am on your side!

By the way, while I think doctors should be paid better than average, most doctors do not go into their professions to get rich quick. It takes a dedicated professional to become a doctor. There are much easier ways to get rich. Maybe if it were not so easy to sue them fewer would leave the profession.

[bgregs]

"By the way, while I think doctors should be paid better than average, most doctors do not go into their professions to get rich quick. It takes a dedicated professional to become a doctor. There are much easier ways to get rich. Maybe if it were not so easy to sue them fewer would leave the profession."

Not to mention if they didn't have to carry CRUSHING insurance, and if they didn't have to have student loans into the millions....

[woundedduck]

For Bernie's plan to get going, Pelosi and Reid need to be removed from leadership.

[somekid1234]

Fully socialized universal health care please. No more health insurance companies!

[UnbiasView]

Says the person that can't get it from anyone but the government.

[bgregs]

Yeah, since the private insurance companies have decided that the "risk" is too high! Or maybe that it's not too high, but it's higher than normal, so they will charge more than normal, which is ALREADY too high!

[indypete]

We're sorry, we have to deny your claim because you had a zit on your nose 19 years ago and didn't mention it on your application (check the 23 pages of fine print on the form... what's that, you're not a lawyer? You don't speak fluent obfuscation?). We knew about it immediately because of the exhaustive background check we perform on all our clients but decided it was a snippet of information we'd keep to ourselves. The premiums you paid for all those years that you wouldn't have paid had we rejected your application on those grounds? Well keep them to ourselves too. Good luck with your cancer.