Opinion and conjecture abound on the prospect of changing how to pay for medical care in Oregon and across the U.S. Honest concern about fundamental changes to medical care in our country is understandable. After all, even small missteps in regulation or funding of such a massive a system – projected to rise to nearly a quarter of the U.S. economy – could lead to collapse, leaving even more people unable to access care and devastating other parts of the economy. Sadly, much of the discourse has had an angry, fearful tone. Many citizens with justifiable concerns are being used unfairly by special interests that have an agenda reaching no farther than the next election cycle. But hyperbole and intolerance have no meaningful place in this debate.
Instead, consider the health care system we have now and what is at stake if we do nothing. Each year the cost of our medical system rises while wages remain flat. If we do nothing, U.S. health care will collapse under its own weight. We spend $7,000 per person annually in our country, more than any other nation. In spite of this staggering price tag, we have shorter life spans, more burden of disease, and a generally less healthy population than nations spending a fraction as much. We ranked 37th between Costa Rica and Slovenia in a study by the World Health Organization, and of 19 industrialized nations, the U.S. ranks last in the care for treatable illnesses. There are nearly 50 million uninsured people in the U.S., and here in Central Oregon the proportion of uninsured is even higher because of our younger, more mobile population.
Our health system is also an anchor dragging down business and economic prosperity. When uninsured patients are admitted to hospitals and bills go unpaid or only partially reimbursed, it costs hospitals more than $34 billion each year, more than five percent of total hospital revenue. Further, medical costs helped spur the collapse of the U.S. automobile industry and attach a hidden price tag to anything manufactured in America, making our goods less competitive in foreign markets whose businesses do not have to provide for their employees’ medical coverage.
Even some who accept that allowing millions to go uninsured is wrong still argue for a market-based approach or insist that government involvement will lead to rationing. However, the past 50 years have shown that a purely free-market approach is neither cost effective nor better at making people healthy. And we need only look to our current system to see rationing in its most unjust form. Private insurers ration care because it is plain good corporate policy. Corporations operate to maximize profits, not provide medical care. In fact, paying for our care hurts the bottom line to the degree that private insurers spend a hefty sum in efforts to deny coverage, avoid paying for medical bills, and placing obstacles in the way of seeing a physician. Over 60 percent of bankruptcies are medically related. Even worse, uninsured patients who may receive their care in emergency rooms get inadequate preventative care and follow-up, and are often rationed right out of medical care completely. Treatment decisions should be between patients and their physicians, not a corporation bent on providing the least amount of care for the most shareholder profit. Rationing is not part of proposed medical reform plans, and the form of rationing we have now must be stopped.
Consider what we rely on our government to provide for us already – roads, national defense, law enforcement. Rarely do we clamor to build a highway or raise an army out of our own pockets. Health care in the U.S. is no less expensive yet we place its cost on the shoulders of those least able to afford it, the infirm and elderly. Why not instead look for examples of what our government has done well already. Medicare and social security are some of the most popular programs ever enacted. Both were controversial in their day but have proven quite effective at providing care to those over 65. There is little discussion about rationing within Medicare because without needing to turn a profit from patients or requiring expensive efforts directed at denying care, this government-sponsored health insurance costs less and operates more efficiently.
The prospect of health reform is as much an opportunity as it is a challenge. But as frightening as it may be, it is far less scary than the ailing system we have now. These are serious times that demand serious participation by all of us as members of a civilized nation. Change is in our nature as Americans and we have risen to the challenge before emerging a stronger and more prosperous people for it. We must do so again now. This is no time to fall prey to special interests intent on maintaining a failed status quo. The time for allowing millions to go without adequate medical care is over. We must demand of our elected officials, a strong government-sponsored plan to ensure everyone receives the medical care they need. Not because it is the only morally acceptable thing to do, but because financially we can no longer afford to do otherwise.
Dr. Boddie is a hospitalist physician in Bend and Redmond. He has worked for many years on health policy, global health, and environmental issues. Trained in internal medicine, Dr. Boddie previously worked with medically underserved populations in New York, Guyana, South America, and Uganda. He has also worked within the NHS, the British health system. He looks forward to health reform allowing greater access to care for his patients in Central Oregon.
This article appears in Sep 10-16, 2009.
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Nathan,
I appreciated and agree with your thoughtful assessment of our urgent predicament and need to cover the uncovered.
I’m working on specific options for “reformatting” the current private provider and hospital resources to Co-op with subscribers -patient as potential “owners” of their own health care system.
I grew up in Bend and have family there. I have practiced rheumatology in Portland for 30 yrs. Another of my projects is chronic pain and I’m working on balanced “advocacy” for specific patient populations like this.
Let me know if you would like share more ideas or collaborate.
Kip Kemple
sure the government runs other businesses into the ground. when they started social security they never imagined the cost and the size and its weight. the system would work in any industry if you the government would just promote competition instead of conglomerates. whats wrong is this to big to fail philosophy. At this rate we must support walmart so we are all insured cheap food. Why stop at taxing people with high risk consumption. I think we should give people a break if they exercise right. OH I mean the right type of exercise. I think we should tax running shoes more than other shoes to promote power walking rather than jogging. I also think we should go after high heels because a study shows they can be linked to back problems. I’m not even going to talk about high risk sports and the health problems associated with them. The government has no right to tell me what to eat, how much i need to sleep, how much I move. I’m not for doing nothing but we need common sense. The system is competition. If you have banks or health care industries get to big were they can control prices you break them up, to increase competition. Instead they are creating such lobby power that congress wont take them on. When they should be broken up and able to compete across state lines. If you let any industry go until there is one or two winners we will face this problem in every sector. One safeway one tacomcdebell, one exxon. If you want to give 30 million people insurance do it. At an average of some 200 dollars per person for some basic coverage that’s 60 billion . Pay it and lets move on. Put term limits on these white house guys and make them follow threw on antitrust laws. People need to take macroeconomics and microeconomics if you want talk about how to fix the system rather than car is broken I think its the tailpipe because no smoke comes out of it.
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