For Joel Segal, it was the day he was kicked out of George Washington Hospital, still on an IV after knee surgery, without insurance, and with $100,000 in medical debt. For Kiki Peppard, it was having to postpone needed surgery until she could find a job with insurance—it took her two years. People all over the United States are waking up to the fact that our system of providing health care is a disaster.
An estimated 50 million Americans lack medical insurance, and a similar and rapidly growing number are underinsured. The uninsured are excluded from services, charged more for services, and die when medical care could save them—an estimated 18,000 die each year because they lack medical coverage.
Businesses are suffering too. Insurance premiums increased 73 percent between 2000 and 2005, and per capita costs are expected to keep rising. The National Coalition on Health Care (NCHC) estimates that, without reform, national health care spending will double over the next 10 years. The NCHC is not some fringe advocacy group—its co-chairs are Congressmen Robert D. Ray (R-IA) and Paul G. Rogers (D-FL), and it counts General Electric and Verizon among its members.
Employers who want to offer employee health care benefits can't compete with low-road employers who offer none. Nor can they compete with companies located in countries that offer national health insurance.
The shocking facts about health care in the United States are well known. There's little argument that the system is broken. What's not well known is that the dialogue about fixing the health care system is just as broken.
Among politicians and pundits, a universal, publicly funded system is off the table. But Americans in increasing numbers know what their leaders seem not to—that the United States is the only industrialized nation where such stories as Joel's and Kiki's can happen.
And most Americans know why: the United States leaves the health of its citizens at the mercy of an expensive, patchwork system where some get great care while others get none at all.
The overwhelming majority—75 percent, according to an October 2005 Harris Poll—want what people in other wealthy countries have: the peace of mind of universal health insurance.
A wild experiment?
Which makes the discussion all the stranger. The public debate around universal health care proceeds as if it were a wild, untested experiment—as if the United States would be doing something never done before.
Yet universal health care is in place throughout the industrialized world. In most cases, doctors and hospitals operate as private businesses. But government pays the bills, which reduces paperwork costs to a fraction of the American level. It also cuts out expensive insurance corporations and HMO's, with their multimillion-dollar CEO compensation packages, and billions in profit. Small wonder "single payer" systems can cover their entire populations at half the per capita cost. In the United States, people without insurance may live with debilitating disease or pain, with conditions that prevent them from getting jobs or decent pay, putting many on a permanent poverty track. They have more difficulty managing chronic conditions—only two in five have a regular doctor—leading to poorer health and greater cost.
The uninsured are far more likely to wait to seek treatment for acute problems until they become severe.
Even those who have insurance may not find out until it's too late that exclusions, deductibles, co-payments, and annual limits leave them bankrupt when a family member gets seriously ill.
In 2005, more than a quarter of insured Americans didn't fill prescriptions, skipped recommended treatment, or didn't see a doctor when sick, according to the Commonwealth Fund's 2005 Biennial Health Insurance Survey.
People stay in jobs they hate—for the insurance. Small business owners are unable to offer insurance coverage for employees or themselves. Large businesses avoid setting up shops in the United States—Toyota just chose to build a plant in Canada to escape the skyrocketing costs of U.S. health care.
All of this adds up to a less healthy society, more families suffering the double whammy of financial and health crises, and more people forced to go on disability.
But the public dialogue proceeds as if little can be done beyond a bit of tinkering around the edges. More involvement by government would create an unwieldy bureaucracy, they say, and surely bankrupt us all. The evidence points to the opposite conclusion.
The United States spends by far the most on health care per person—more than twice as much as Europe, Canada, and Japan which all have some version of national health insurance. Yet we are near the bottom in nearly every measure of our health.
The World Health Organization (WHO) ranks the U.S. health care system 37th of 190 countries, well below most of Europe, and trailing Chile and Costa Rica. The United States does even worse in the WHO rankings of performance on level of health—a stunning 72nd. Life expectancy in the U.S. is shorter than in 27 other countries; the U.S. ties with Hungary, Malta, Poland, and Slovakia for infant mortality—ahead of only Latvia among industrialized nations.
The cost of corporate bureaucracy
Where is the money going? An estimated 15 cents of each private U.S. health care dollar goes simply to shuffling the paperwork. The administrative costs for our patched-together system of HMO's, insurance companies, pharmaceutical manufacturers, hospitals, and government programs are nearly double those for single-payer Canada. It's not because Americans are inherently less efficient than Canadians—our publicly funded Medicare system spends under five cents per budget dollar on administrative overhead. And the Veterans Administration, which functions like Britain's socialized medical system, spends less per patient but consistently outranks private providers in patient satisfaction and quality of care.
But in the private sector, profits and excessive CEO pay are added to the paperwork and bureaucracy. The U.S. pharmaceutical industry averages a 17 percent profit margin, against three percent for all other businesses. In the health care industry, million-dollar CEO pay packages are the rule, with some executives pulling down more than $30 million a year in salary and amassing billion-dollar stock option packages.
Do those costs really make the difference?
Studies conducted by the General Accounting Office, the Congressional Budget Office, and various states have concluded that a universal, single-payer health care system would cover everyone—including the millions currently without insurance—and still save billions.
Enormous amounts of money are changing hands in the health-industrial complex, but little is going to the front line providers—nurses, nurse practitioners, and home health care workers who put in long shifts for low pay. Many even find they must fight to get access to the very health facilities they serve.
Doctors complain of burnout as patient loads increase. They spend less time with each patient as they spend more time doing insurance company mandated paperwork and arguing with insurance company bureaucrats over treatments and coverage.
Americans know what they want
In polls, surveys, town meetings, and letters, large majorities of Americans say they have had it with a system that is clearly broken and they are demanding universal health care. Many businesses—despite a distaste for government involvement—are coming to the same view. Doctors, nurses, not-for-profit hospitals, and clinics are joining the call, many specifically saying we need a single-payer system like the system in Canada. And while we hear complaints about Canada's system, a study of 10 years of Canadian opinion polling showed that Canadians are more satisfied with their health care than Americans. Holly Dressel's article shows why.
Although you'd never know it from the American media, the number of Canadians who would trade their system for a U.S.-style health care system is just eight percent.
Again, the public dialogue proceeds from a perplexing place. Dissatisfied Canadians or Britons are much talked about. But there's little mention of the satisfaction level of Americans. The Commonwealth Fund's survey, for instance, shows that, in 2005, 42 percent of Americans doubted whether they could get quality health care. At a series of town hall meetings in Maine, facilitators asked participants to discuss dozens of complex health care policies but excluded single-payer as an option. (See Tish Tanski's article.) Only after repeated demands by participants was the approach that cuts out the corporate middle-men allowed on the list.
The same story played out across the country at town meetings convened by the congressionally mandated Citizens' Health Care Working Group. In Los Angeles, New York, and Hartford, participants simply refused to consider the questions they were given about tradeoffs between cost, quality, and accessibility. They insisted that there's already enough money being spent to pay for publicly funded universal health care.
But it's not only about the money. Comments from participants in the town meetings, from Fargo to Memphis, from Los Angeles to Providence, revealed an understanding that this is about a deeper question. It is an issue of the sort of society we want to be—one in which we all are left to sink or swim on our own or one in which we recognize that the whole society benefits when we each can get access to the help we need.
Likewise, when we asked readers of the YES! email newsletter what would make you healthier, nearly all answered in terms of “we.” Any one of us could get sick or be injured. Any one could lose a job and with it insurance. Our best security, they said, is coverage for all.
What form might this take?
As elections near and the issue of health care tops opinion polls as the most pressing domestic issue, various proposals for universal health care are circulating. The bipartisan NCHC looked at four options: employer mandates, extending existing federal programs like Medicaid to all those uninsured, creating a new federal program for the uninsured, and single-payer national health insurance. All the options saved billions of dollars compared to the current system, but single payer was by far the winner, saving more than $100 billion a year.
Meanwhile, the Citizens' Health Care Working Group, which held those town meetings around the country, has issued interim recommendations. They state the values participants expressed: All Americans should have affordable health care, and assuring that they do is a shared social responsibility. Sadly, that bold statement is followed by inconclusive recommendations: more study, no preference for public funding, and a strong commitment to get everybody covered by 2012—but with no means to do it. The commission will make final recommendations to the president and Congress, and is accepting public comment through the end of August.
What is the obstacle?
With all the support and all the good reasons to adopt universal health care, why don't we have it yet? Why do politicians refuse to talk about the solution people want?
It could be the fact that the health care industry, the top spender on Capitol Hill, spent $183.3 million on lobbying just in the second half of 2005, according to PoliticalMoneyLine.com. And in the 2003–2004 election cycle, they spent $123.7 million on election campaigns, according to the Center for Responsive Politics.
Politicians dread the propaganda barrage and political fallout that surrounded the failed Clinton health care plan. But in the years since, health care costs have outpaced growth in wages and inflation by huge margins, Americans have joined the ranks of the uninsured at the rate of 2 million each year, and businesses are taking a major competitiveness hit as they struggle to pay rising premiums.
Healthcare-Now (www.healthcare-now.org) is holding town hall meetings throughout the United States (they've held 93 so far), and people are pressing their representatives to take action. Over 150 unions have called for action on universal health care, and polls show overwhelming majorities of Americans feel the same way.
Some political leaders are pressing for universal health care. Remember Joel, who was kicked out of the hospital with $100,000 in medical debt? He started giving speeches about the catastrophe of our health care system, and eventually got hired by Rep. John Conyers (D-MI) to head his universal single payer health care effort. Conyers' "Medicare for All" bill now has 72 co-sponsors. Rep. Jim McDermott's (D-WA) Health Security Act has 62.
Around the United States, state and local campaigns for universal health care are making progress. (See Rev. Linda Walling's update).
One of these days, the lobbyists and their clients in government may have to get out of the way and let Americans join the rest of the developed world in the security, efficiency, and quality that comes with health care for all.
See Health Care Options at a Glance for chart comparing Socialized vs Single-Payer vs Nonprofit Multi-Payer vs Corporate Health Care
Correction: the original print version of this article contained a reference to Health Care for All holding town meetings. It is Healthcare-Now that is holding the town meetings.