Magazine article Clinical Psychiatry News

What Is the Best Way to Reform the U.S. Health Care System?

Magazine article Clinical Psychiatry News

What Is the Best Way to Reform the U.S. Health Care System?

Article excerpt

Single payer is the way to go.

The health care financing organ in the United States is failing. It has all the manifestations of a patient with heart failure.

We have poor output, where we can't circulate health insurance to cover the entire population, so we have poor health outcomes. We have swollen costs and unaffordable health care, with tremendous waste and squandering of resources. Finally, we have increased afterload, which is the resistance among special interests to the change necessary to create a healthier system.

The number of Americans with no public or private insurance grew from 22 million people in 1976 to more than 46 million in 2004. The Institute of Medicine has said that lack of insurance is directly accountable for 18,000 excessive deaths annually.

Surveys of residents of the United States and Canada, asking people if they have difficulty getting the health care they need because of unaffordability, show that access to medical care is a problem for 5% in Canada and 24% in the United States. Access to tests and treatment is a problem for 6% and 22%, respectively. Access to prescription drugs is a problem for 13% and 26%, respectively.

Is U.S. health care the best in the world? The World Health Organization ranks U.S. health care 37th out of 191 countries evaluated. Despite this poor performance, we spend nearly twice as much per capita on health care compared with single-payer countries. The incredible inefficiency of our insurance system partly explains the swollen U.S. costs.

People in countries that regulate pharmaceutical prices pay, on average, half of what U.S. residents pay for drugs. This is partly why we have such resistance to political change: Pharmaceutical companies are incredibly profitable corporations and don't want the system altered.

Definitive treatment would be to remove this structurally defective, ailing health financing system and replace it with a new, healthy organ--a single-payer health insurance plan that would provide universal, equitable coverage with fair distribution of financing. It would be publicly administered; collect revenues from existing Medicare, Medicaid, and payroll taxes; and put revenues into a common pool. Operated at a national level, it would essentially be Medicare for all. It would pay for prescription drugs, visits to physicians and hospitals, and options for well-integrated health systems like Kaiser Permanente, without spending a dollar more than we spend today.

Opponents say a single-payer system will lead to rationing. We ration care every day in the United States primarily based on whether someone can afford to pay for it and has insurance. It would be far better to allocate services based on people's health care needs.

Others worry that it would threaten physician income, but physicians in Canada do very well. Another fear is that a single-payer system would stifle innovation. That's nonsense. The single greatest source of U.S. innovation is the National Institutes of Health.

A single-payer program could be definitive therapy for a tremendously sick system.

DR. GRUMBACH is professor and chair of family and community medicine at San Francisco General Hospital.


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