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Rapid Responses: Rapid Responses published:
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Solution Pending
- Robert G Burney MD, Washington, DC 20522 (20 February 2007)
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Complex Solution Made Simple
- Rebecca A. Spoon (24 February 2007)
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A Genuine Solution to America's Health Care Crisis
- Ronald Codario (27 February 2007)
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Robert G Burney MD, Director, Quality Improvement US State Department, Medical Services, Washington, DC 20522
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Like many others, Karen Davis proposes purchasing insurance for the uninsured with taxes. While this seems logical, it will also increase the overall cost of healthcare by injecting more money into the system. The chief beneficiaries will be institutional providers who are already receiving some compensation and will now receive more. Furthermore, it is not clear that this would solve the problem. Some "uninsured" are already receiving care, and others don't need it. Also, there are factors other than insurance that prevent patients from obtaining healthcare. In her table, the only parameter that is clearly related to healthcare is breast cancer 5 year survival, and here, the US leads the pack. For others the data are suspect or the parameter is more clearly related to factors other than healthcare (e.g. life expectancy). Healthcare for those who need it is indeed a problem, but the solution is more complex than just purchasing more insurance. R. Burney MD burneyrg@metronets.com Competing interests: None declared |
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Rebecca A. Spoon, small business owner Charleston, IL 61920
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Dr. Burney says the "solution" to our health care crises is complex. Indeed, by simply following the money, anyone can see that we have a huge, unnecessary middleman diverting at least 31% of our health dollars away from desperately needed care, keeping health care consumers divided, conquered, and from utilizing efficiencies of scale. "Eliminating unnecessary middlemen and utilizing efficiencies of scale" is basic business common sense. A small fraction of the costs of overhead, administration, advertising, profits, dividends and CEO salaries created by profit-driven health insurers (and thereby diverted away from care providers and consumers), could relatively easily and conceivably be used to cover all mental, dental, prescription, long-term and necessary health care for all Americans while still leaving billions of dollars in savings left over for other sectors of our economy. From consumers' standpoint, the larger the risk group we are in, the better the coverage and the lower the price. If all health care consumers were in one large risk group under one set of consistent rules (basically if we are sick, we are covered), not only would we save billions of dollars every year collectively, but also would finally be able to see who is paying how much for what, thereby achieving the transparency we currently lack but is crucial to being able to hold down future cost increases to reasonable levels. Put even more simply, we can't and won't create a cost-effective, high quality health care system for all Americans under 65 while we keep maintaining a broken status quo that places profits before people and money before morality. Is it too much to ask the profit-driven health insurance industry to figure out other ways to make money that do not kill, disable and bankrupt millions of innocent Americans in numbers that any Al Qaeda could only hope to achieve? Some things are more important than money, and the more Americans that forget that, the worse off we all are. The irony is that we're paying more for our under and uninsured under the profit-driven system we have now than they would cost us otherwise, and in so many ways, including dollars, human suffering and lost productivity. We have a "Pay More Get Less" system that desperately needs to "Get Real". Millions of us see what obviously needs to be done; all we lack is the political will. Competing interests: None declared |
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Ronald Codario, 4th Year Medical Student Georgetown University, 20057
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Ms. Davis: I greatly appreciate the important issues you address in the article "Uninsured in America." Your summary of the American health care paradox of dwindling coverage and rising costs appropriately highlights the major systemic challenges, but I noticed a key omission in your list of suggested government actions, namely universal single-payer or national health insurance. This proposal, most currently in the form of House Resolution 676, involves eliminating the role of private insurance and creates a single, publicly administered insurer. By expanding and improving Medicare and creating one risk pool for all Americans, single-payer is the simplest and most cost efficient means of providing universal healthcare. The three key ways in which single-payer health insurance differs from all other proposals are in the realms of access, administrative costs, and monopsony buying power. In terms of access, every U.S. resident would be covered under the same insurance system such that patient's would have absolute freedom to select any physician. This could easily be achieved at little to no increased cost to the American taxpayer, largely due to the savings accrued by eliminating the administrative waste of the private insurance companies. As it is, roughly thirty cents of every dollar spent on healthcare in America goes toward administrative costs (including corporate profits and executive salaries). Medicare, the model for single -payer health insurance, spends about 2-3% on administrative costs, while private insurance companies spend several fold more (some close to 30%). Furthermore, strategies that involve private insurance bolster wasteful administrative spending on the provider side. Hospitals and doctor's offices are forced to allocate a large portion of their resources to deal with the complexity of dozens of different insurance companies all with different formularies and claims forms. Another way in which single-payer reduces costs is through monopsony buying power, which can be used to negotiate for lower drug prices from pharmaceutical companies. Currently, America's fractured system of coverage makes it difficult (and in the case of Medicare Part D, forbidden) to negotiate with the pharmaceutical industry. Under single- payer health insurance, these companies would have no choice but to negotiate with one, powerful insurer covering all Americans. For these reasons and many more, I urge you to consider single-payer health insurance in future discussions of solutions to America's health care crisis. Competing interests: None declared |
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