Uninsured in America: problems and possible solutions
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39091.493588.BE (Published 15 February 2007) Cite this as: BMJ 2007;334:346
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
A Genuine Solution to America's Health Care Crisis
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
Competing interests: No competing interests