By E. Roberts Musser –
The current political mantra at both the federal level and here in the state of California is the perceived need for “universal health care”. It is seen as the solution to the crucial issue of health care reform. Rather the more important question should be: “Is universal health care the answer to rising health care costs and the ever increasing number of uninsured, or are there other options to consider that might be better?”
Medicare is essentially “universal health coverage” for the elderly throughout the United States. Medicare coverage is provided to those 65 years of age and older, and the disabled (according to federal government standards). So the obvious inquiry is how is the Medicare arrangement working? According to an April 2009 article in the New York Times, Medicare has its dark side.
Just as those who become eligible for Medicare hunt for a doctor willing to take government insurance, they find physicians will not take on new Medicare patients. The following reasons provide the explanation for this alarming trend: 1) reimbursement rates from Medicare are too low to cover actual costs, 2) Medicare paperwork is not worth the aggravation; 3) there is a shortage of doctors nationally.
So what is a patient to do? Many are flocking to urgent care centers, staffed by doctors who perform simple services. The majority of these centers will take Medicare patients. Another, more expensive option is concierge care, where physicians taking Medicare patients charge the patient an annual retainer to get a foot in the doctor’s door. Annual retainers can range anywhere from $1,500 to $15,000 a year, depending on the level of service contracted for.
In April 2006, the state of Massachusetts became the first state in the country to require mandatory health insurance for its citizens. It was hailed by analysts as an “innovative bipartisan plan” representing the centerpiece for “universal” health care law. The purpose of this legislations was twofold: reduction of health care costs, and guaranteeing coverage for all Massachusetts residents.
As indicated in a Fall, 2008 article in The Objective Standard, the Massachusetts plan consisted of the following elements:
- Establishment of a quasi-governmental authority, to serve as a clearinghouse through which individuals could purchase state-approved plans;
- Every resident would be required to purchase a health insurance plan, either from a private insurer or through the state;
- Residents who could not afford insurance would have their expenses subsidized by the state in part or full, depending on level of income;
- Employers with more than ten employees would be required to provide health insurance for their workers or pay a special fee to subsidize coverage of low income individuals.
How has the Massachusetts model fared? The results are grim at best. The plan has increased costs for individuals and the state; reduced revenues for doctors and hospitals to the point where patients cannot obtain adequate care; and left officials admitting “universal coverage is not likely to be universal any time soon”. Why did this happen?
Costs of health insurance for Massachusetts residents has risen dramatically because the government was allowed to define what constitutes an acceptable policy. In consequence, special interest groups lobbied politicians to include their pet benefits as part of the government approved plan, typified by in vitro fertilization and alcoholism therapy. These more exotic mandated benefits raised the costs of health insurance in Massachusetts from 23% to 56%, 85% more than originally projected.
Because of increasing costs, the state government cut payments to doctors and hospitals. Often state insurance reimbursement payments do not cover expenses. As a result of rising costs and falling revenues to the state, access to medical care has dwindled for many patients. Fewer doctors are willing to take on new patients with government insurance for fear of losing money. State reimbursement paperwork is a veritable “nightmare”. Thus patients face long waits for basic medical care.
These problems are only going to worsen with time. Massachusetts insurance prices will rise 10 percent or more next year, twice the rate of increase for the national average. State subsidies are expected to double over the next three years. Accordingly, the state has asked the federal government for assistance w its shortfall. State tax increases are in the offing, with businesses and insurers soon required to pay more to fund the program. Payments to doctors and hospitals will be slashed again, making it that much harder to obtain access to medical care.
Based on a Summer 2007 piece in the City Journal, written by Canadian author David Gratzer, Canada has a single-payer system, in which the government finances and provides all health care, often referred to as “socialized medicine”. Similar socialized medicine structures are found throughout Europe, such as in France, Great Britain, and Sweden. The myth is that Canada’s health care system is entirely government run. And how well is the Canadian system working?
A new trend in Canadian health care has appeared on the scene: to find needed treatment in another country (particularly the United States), then sue Canadian bureaucrats to pay for it. Why? Because at a time when Canada’s population is aging and needs more care rather than less, the bean counters in the Canadian government have drastically cut costs, reducing the size of medical school classes, closed hospitals, and capped doctor’s fees. Patients are suffering and dying from the severe delays. This unfortunate state of Canadian health care is chronicled in Mr. Gratzer’s 1999 book, Code Blue.
Things have gotten so out of hand another new phenomenon has emerged in Canada – “medical brokers”. Canadians will often pay a broker to set up medical services quickly – private medical services found not only outside Canada but within the country itself. Fed up with the situation, Canadian doctors are setting up their own private clinics. This privatizing trend in socialized medicine is reaching Europe as well. Ironically, as the United States heads toward socialized medicine, socialized medicine is heading towards privatization!
According to a March 2005 CBS News article, Ontarians spend about 40% of every tax dollar on health care. As maintained by the Canadian Taxpayers Federation, the Canadian health care system is going broke. The federal government and virtually every province acknowledges there is a national crisis in Canadian health care: lack of doctors, nurses, equipment, funding. Those with connections jump to the head of the medical queue, and those that can afford it get treated in the U.S.
Health Care in the United States
Canadian author Gratzer points out that if we measure a health-care system by how well it serves its sick citizens, American health wins hands down. The American five year cancer survival rate for leukemia is 50 percent, whereas the European rate is just 35 percent. The survival rate for prostate cancer in the United States is 81.2 percent, yet only 61.7 percent in France and a mere 44.3 percent in England.
The life expectancy rate for Americans may be slightly lower (75.3 years) than that of Canadians (77.3 years) or the French (76.6 years). However we don’t kill off our ill, as other countries do – when socialized medicine systems fail to provide necessary health care. The interesting thing is Americans who don’t die in car crashes or homicides outlive people in any other Western country. One wonders if American politicians shouldn’t be more aggressively addressing the problem of drunk driving and unacceptably high crime rates in this country.
A panel of health care professionals and analysts discussed health care reform at Baldwin-Wallace College in March of 2009. Many ideas were offered, but it became clear caregivers, patients and insurers may not be willing to make the sacrifices necessary to support quality health care for all. The conclusions reached are listed below:
- Doctors would have to accept less payment and do more to keep patients well;
- Patients would have to take responsibility for living healthier lifestyles and pay for some of their care;
- Private insurers would have to accept lower profits and executive compensation. All insurers, including Medicare/Medicaid, would have to find ways to get everyone in the system to minimize cost and maximize benefits.
- Drug and device makers would have to accept reasonable payments for their products and develop products that save money.
The Objective Standard offers the following thoughts for health care reform:
- Eliminate insurance benefit mandates and other laws that prohibit individuals from purchasing insurance across state lines.
- Permit all individuals to establish Health Savings Accounts to pay for small routine expenses, so insurers can offer lower cost, catastrophic-only insurance policies.
- Allow individuals to purchase health insurance with pretax dollars, which would eliminate the tax penalty incurred when health insurance is purchased separate from employer offerings.
There is an old adage which comes to mind, which I think applies in the naïve and frantic scurry to institute “universal health care“: “Fools rush in where angels fear to tread.” It is obvious, if one does the requisite research, currently existing forms of universal health care have serious, inherent problems. I believe this is why some politicians, such as our very own Senator Lois Wolk, are hesitant to jump on the universal health care bandwagon. It would seem imprudent to introduce a scheme into the equation, that doesn’t pencil out as effective.
Lesson to be learned: With any plan of action, the devil is in the details. There must be more than just a wish list, when creating a program. It is imperative proper examination be undertaken – to determine what has worked, what hasn’t done well, and analyze why.