Medical Care for All

Our Present Health Care System Fails

Our United States is the only developed country without universal health care paid for by the government.

We spend 50% more per capita than any other county for our combination of government, employer and self paid for health services. Statistics which measure our health are lower than for many other countries which spend much less for health care. Health care costs are skyrocketing. Government health coverage costs are overwhelming national and state budgets. Employer paid health insurance reduces the number of people companies will hire and disadvantages them in competition with foreign companies. Employers are eliminating or reducing health care benefits such that employees and younger retirees are paying higher proportions of their health care costs. Recent bankruptcy legislation means many Americans without health insurance who become expensively ill will lose virtually all of their assets.

The Bush administration and Congress are doing virtually nothing to meet these challenges. Some states are attempting to find ways to improve coverage of their residents. Yet these attempts are woefully inadequate and even hindrances to achieving what is needed: universal health coverage with cost controls. Massachusetts is currently being praised for requiring that all persons purchase health insurance from insurance companies. This would produce a guaranteed market for health insurance companies, with resulting increases in health care costs.

Universal Coverage with Cost Controls

What is needed is what other countries have – universal coverage with cost controls. Universal coverage and cost control requires that the government must pay for everyone’s basic healthcare, with the government bargaining with health care providers to limit their prices. The government must decide how much it can afford for health care and then limit the treatments it will cover on the basis of their cost-benefits. This will result in the government spending much less for treatment of people who are terminally ill, with little time to live. Insurance companies will only be able to provide supplemental coverage directly to individuals.

How do we obtain cost controlled universal health care? We should first institute cost controls for our Medicare, Medicaid, veteran’s, federal employees and other government paid health coverage, but eliminating coverage of the least cost-beneficial treatments that force health care costs over budgetary limits. We should then begin insuring young children and then increasing the ages at which they are insured. And begin reducing the age for Medicare from 65 to lower and lower ages, until everyone is covered.

Private Insurers Cost Too Much

Massachusetts is getting publicity for their attempt to ensure all their residents. It will require employers to provide health insurance. It will require all people without government or employer paid health insurance to purchase it, with subsidies for those with lower income. Some cost controls are attempted, but these do not include excluding coverage of treatments with low cost-benefit ratios.

I believe this approach will fail due to high uncontrolled costs. By forcing people to buy health insurance, Massachusetts is providing a huge subsidy to private insurance companies who siphon off a much higher percentage of health care payments than occurs when the government pays directly for services, such as occurs under Medicare. Without eliminating coverage of low cost-benefit treatments, a high percentage of medical payments go for treatment during the last few months of patients’ lives.

Implementing Universal Coverage

The approach that will work is to eliminate Medicare coverage of low cost-benefit treatments and then use the saved money to extend Medicare coverage from age 64 down and from age 0 up. Covering children is relatively inexpensive. Covering older people is more expensive, but more valuable because they are more likely to become ill. Low income people of covered ages will receive Medicare instead of Medicaid, saving money now spent on means-testing. As more people are covered by Medicare, employers and employees will save money now spent on private insurance and co-pays. Some lf the money saved can be taxed to support further Medicare coverage.

Without huge medical payments, businesses will become more competitive. These comments don’t address many other health care proposals oriented to improving quality of health care and controlling costs, such as paying for performance, encouraging best practices, better informing consumers, bargaining with providers (including pharmaceuticals), etc. Dave Thomas