Magazine article The Wilson Quarterly

Health Care's Continuing Crisis

Magazine article The Wilson Quarterly

Health Care's Continuing Crisis

Article excerpt

A SURVEY OF RECENT ARTICLES

PRESIDENT GEORGE W. BUSH'S low-key call in his State of the Union speech for an expansion of health savings accounts has momentarily put America's simmering health care problems back in the spotlight. At last count, in 2004, more than 45 million Americans had no health insurance--an increase of six million since 2000, caused mainly by the erosion of employer sponsored health benefits. At the same time, the cost of health care has continued to rise rapidly.

Several articles by noted specialists in Boston Review (Nov.-Dec. 2005) offer a good overview of the current state of the debate in the field. John Geyman, a professor emeritus of family medicine at the University of Washington, Seattle, argues that after all the failed reform efforts of the last 30 years--from managed care to health maintenance organizations to preferred provider organizations and consumer directed health care-the time has come for national health insurance.

Under such a plan, every American would be covered for "all medically necessary services." There would be no copayments or deductibles. Though insurance would be publicly financed, perhaps by a payroll tax, health care delivery would remain private, and individuals would be free to choose their own physicians and other providers. Hospitals and other institutions would negotiate their compensation with the government. Bulk purchases of prescription medicines alone would save $50 billion annually. In essence, says Geyman, establishing a national health insurance system would be equivalent to extending the Medicare program for the elderly to all Americans. With 41 million highly satisfied customers and administrative costs of only 3 percent (versus 26.5 percent for investor-owned Blue Cross), Medicare is hard to beat.

Surveys over the last half-century typically have shown that most Americans favor national health insurance, "even when they are told that taxes will be raised and the program will be 'government-run:" He thinks that businesses hurt by ever-rising health care costs will soon be ready to sign on too.

Wishful thinking, say Ezekiel J. Emanuel of the Magnuson Clinical Center, National Institutes of Health, and Victor R. Fuchs, a professor emeritus of economics at Stanford University. The single-payer method has some virtues and at least one big problem: Its one-size-fits-all approach, along with its prohibition against individuals buying additional insurance and services on their own, runs counter to "deeply entrenched American values." Unlike Canadians and Europeans, Americans value individualism and personal choice at least as much as they do equality. And, as a practical matter, conservatives and business will never consent to a single-payer plan.

Single-payer plans are also "bad policy." For one thing, they would institutionalize the costly and inefficient fee-for-service reimbursement of doctors. And by promising comprehensive benefits while lacking the private market to restrain rising costs, single-payer plans invite "financial disaster." Medicare, far from being the model program Geyman claims, illustrates the problem. By 2020, the Medicare Trust Fund will be empty and the program will be devouring five percent of gross domestic product; in 75 years, costs are projected to exceed all of the federal government's tax revenues. …

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