In the days before the primary election on Feb. 5, Progressive Nashville takes a look at where America stands on some important issues and, on Friday, where we should be going.
Today we look at health care.
America is said to have the best health care system in the world, yet more than 45 million people -- about 15 percent of our population -- don't have health insurance and, thus, don't have full access to the system. Most Americans, according to a recent survey, say they expect to eventually be cut out of the health care system because they cannot afford insurance.
We have the second highest rate of infant mortality in the world.
We've seen people's financial lives ruined when they try to get the health care they need.
Many older Americans are choosing between medicine and food.
This was not the case 40 years ago, according to research by Dr. Rosemary Stephens. At that time, more than 70 percent of the population had some form of hospital insurance by 1965 (though less than one-half of the elderly population did), 67 percent had surgical insurance, and there was a growing market for major medical insurance.
Medicare was created to provide care elderly because their needs were great and private insurance was not available. It was also the first insurance to be available to people regardless or class or other status in society. Private insurance was not as egalitarian and there were large numbers of poor people who, like today, did not have access to health care.
Among the uninsured today, children are more likely to have coverage than adults because of government programs, but that doesn't mean they are safe.
Nearly twenty percent
of uninsured Americans – 8.7 million individuals – are children. While
children are more likely to be insured than non-elderly adults, health
insurance is particularly important for children. Uninsured children
are more likely than insured children to lack a usual source of health
care, to go without needed care and to experience worse health outcomes.
It should also be noted that in 1960, health insurance covered 36 percent of private health spending, while individuals covered the remaining 64 percent out of their own pocket. By 2005, health insurance accounted for 77 percent of private health spending, while out-of-pocket spending accounted for 23 percent of spending.
Looking forward from 1960, researcher Stephens notes, "...many of the problems in medicine that were observed in the 1960s are still with us: lack of insurance (now chiefly among those of working age and children), and instances of professional or bureaucratic carelessness, inhumanity, economic misbehavior, excessive expectations, and still a general bias toward superspecialist rather than primary care."
Despite the lack of real progress in providing more health care, the cost has gone up. In 1960, health care was about five percent of gross national product. By 2005, the number had gone up to nearly 16 percent. While technology has been given credited for the increase, research says that it is responsible only for about half the cost. Costs for hospital stays and physician visits have declined while the cost of prescription medicines have increased.
In more than 40 years, we have extended health care coverage to the elderly and children, but a large percentage of our population still is at risk to a catastrophic health care event. Costs have shifted to private insurers and those costs have increased far faster than the economy has grown.
While costs have shifted to private insurers, there is also evidence that private management has resulted in lower costs. According to a report by Public Citizen, "Studies by both the Congressional Budget Office and the General Accounting Office have repeatedly shown that single-payer universal health care would save significant dollars in administrative costs. As early as 1991, the GAO concluded that if the universal coverage and single-payer features of the Canadian system had been applied in the United States that year, the total savings (then estimated at $66.9 billion) 'would have been more than enough to finance insurance coverage for the millions of American who are currently uninsured.'"
If we are to improve the public health, protect people from catastrophic health care events, and rein in health care costs, we need a new approach to providing care. Private insurance has not been a solution, so it will be up to government to find a way to provide coverage in an affordable way. Medicare and the veterans health care system have already proven that government systems can work.
- Jim Grinstead
Comments