by Lesley Politi on April 24, 2009


Thursday, April 23, 2009

Yes: Too many fall through the cracks, and we pay the price



Years ago, a woman was wheeled into my E.R. in critical condition. She was comatose, and her blood pressure was sky high. I didn’t need a CAT scan to know what was wrong. A vessel deep in her brain had burst, filling her head with blood. She never had a chance.

When I broke the news to her sisters, I learned that she had stopped taking her blood pressure medicine several days before. Why? Although employed, she was uninsured. And when money got tight, she had to choose between buying medicine for herself or food for her kids. Like most moms, she put her children’s needs ahead of her own. She paid for the decision with her life.

This story illustrates what is wrong with America’s health care system. My patient got excellent, high-tech care, but too late to do any good. Ironically, my team’s futile effort to save her life cost far more money than the medicine she needed to stay healthy.

There is great health care in this country, but too often we fall short. According to the CIA’s World Factbook, 40 countries have lower infant mortality rates than ours. We rank 46th in the world for life expectancy at birth. A study of death rates from treatable health conditions ranked the U.S. 19th among 19 wealthy nations — dead last.

One reason America scores so poorly is that we ration health care, based largely on ability to pay. Uninsured Americans get about half the care of insured Americans, so they tend to be sicker and to die sooner.

American health care is incredibly expensive. We pay $2.2 trillion per year — about $7,400 per man, woman and child. That’s twice the median per capita spending of our global competitors – the 30 industrialized nations of the Organization for Economic Cooperation and Development. We pay 16 times the OECD median for private health insurance, and twice as much out-of-pocket. France, Germany, Great Britain and Canada cover everyone, but we spend more public money on health care than they do.

Costs continue to rise. Just last week, The Wall Street Journal reported that some hospitals and big pharmaceutical companies are pushing hefty price increases to boost their earnings.

If these double-digit price increases stand, insurers will pass them on to employers, who will pass them on to us in higher co-pays and deductibles. Over the past nine years, employer-sponsored insurance premiums have risen six times faster than wages.

This can’t continue. Hard-working American families deserve better; so do American businesses that are struggling to compete in the global marketplace. To level the playing field, three things must happen:

First, we need fair rules that promote real competition.

Second, we need a public health insurance option that is affordable and always available. That way, employees of firms that don’t offer coverage and workers who are between jobs will have a competitive alternative to the overpriced and skimpy plans offered through the insurance market.

Third, your doctor needs up-to-date information on the best treatments, so he or she can identify the option that’s best for you.

Health care industry executives and their congressional allies oppose these measures. The outcome of this struggle may determine if you and I can get affordable coverage in the future.

To keep America strong, everyone needs access to quality, affordable care. The best way to do this is craft a uniquely American solution – one that combines private-sector ingenuity with public-sector fairness.


Dr. Art Kellermann is associate dean for health policy, Emory School of Medicine. His opinions are his own.





All Americans want health care coverage. All Americans like choice. Americans who like their current health insurance coverage should be able to keep it.

Those without coverage should have the freedom to choose the most appropriate plan that fits their specific needs and that of their family. But, everyone should have access to affordable health coverage.

President Obama wants to create a public plan option for health consumers under the age of 65. The public plan option will establish a government-run health insurance company — a move that is poised to undermine health care providers, employers and the very sustainability of the entire health care system, not to mention the health and well-being of patients.

Big government should not stick its nose into private markets — much less compete in them.

We have tried something similar to a public plan option. It was called TennCare in Tennessee, and it failed miserably. After the better part of two decades of out-of-control expenditures, TennCare is now being dismantled because it was too bureaucratic, too inefficient, did not improve health outcomes and was costly for taxpayers.

Rather than compete with the private sector, the appropriate role of the government should be to create incentives for innovation through the private health insurance market. Plans must focus on prevention, wellness and effective disease management.

The creation of a government-run health insurance company could jeopardize coverage for 130 million Americans who are currently receiving it through the private sector.

What happens when health insurers begin to withdraw from the private sector? A lack of competition results in higher costs.

Then, we are left with fewer choices of health insurance coverage and even fewer options of medical treatments. Having fewer choices at higher costs of lower quality is not how we believe we should approach reform.

Everyone should be required to have health insurance coverage; or, if they are opposed to insurance, they should post a bond. Insurance can be issued by employers or purchased by an individual from a private health insurance company. If purchased by an individual, they should be able to deduct health insurance premiums from their taxes just like employers can.

The working poor could receive subsidies to help with the cost of coverage. Everyone would have coverage – all 300 million of us.

Our goal should be to have a 300 million-payer system that is individually focused, wellness- and prevention-driven and based in the private sector.

At a time when new scientific breakthroughs are occurring almost daily, we must have a system that accelerates the discovery, development, dissemination and delivery of those solutions that can save lives and create better health.

Yet by their very nature, government bureaucracies are slow, inefficient and stifle innovation. It is exactly the opposite of what we need today.

Actuaries have said that the Medicare system is going to start running deficits as soon as 2017.

If federal bureaucrats can’t manage Medicare, why then do we want these same bureaucrats to run a new government-managed health insurance company?

America has really good sick care, but we need a system that creates incentives for physicians, clinics and hospitals to keep individuals healthy.

We need to let the private sector lead the way by implementing innovations to develop an individually centered, wellness- and prevention-focused, coordinated system of care.


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