When Thomas Jefferson in a fit of rage aimed at King George III wrote that the rights to “life, liberty and the pursuit of happiness” where “inalienable”, he indirectly answered for us the moral question of health care reform in America 200 some-odd-years before it had even become an issue. “Life”, he wrote, is an inalienable, or guaranteed right of all of humanity, and by the very basis of this notion was founded our government institution by the people, “for the people”.
But to formulate a proper understanding of the connection between the Declaration of Independence and the health care overhaul President Obama is tirelessly pushing for, one must declare formally what is the moral question of health care. It is quite simple actually: “Does America, as the richest country in the world, continue to allow 45-47 million Americans go without health insurance for the benefit of the large corporations who refuse to insure them, (or they simply cannot afford to pay), or do we as a country follow the rest of the world and find a way where both the rich and the poor can find equal treatment by covering everyone under a model different from our current?” Once this question is answered, we may begin to look at how the right to “life” could be guaranteed by the government as a whole, not by starting from scratch, but by following the models of countries that have been doing it better than us since even before World War II. This is what I will attempt to explain here.
Feel free to comment below and let me know What you think. Citations for all data can be found below so no dispute to where I get my numbers is necessary.
Firstly, it is fair to say that American ingenuity in the health care industry is unmatched. Our country leads the way in the progression of break-through medicines and procedures, leaving most of the rest of the world in the dust. So whats the problem here if we already have the best health care in the world? Well, according to a report/survey by the United Nations World Health Organization, (WHO), out of 191 countries, the United States placed 55 in overall “fairness of distribution of care”, 72 on “level of health” and 37 on “overall health system performance”. (CITATION 1).
These numbers should be unacceptable in a country that has such an overwhelming majority of the worlds wealth, but this is what our current system provides. This means that 46.6 million Americans do not have any form of health insurance right now and therefore, pay out-of-pocket for care, (an extremely expensive endeavor), or they wait until they are incredibly sick or near death to see a doctor at an emergency room for free. (CITATION 2). Because of this, roughly 45,000 Americans yearly will die from not having any form of insurance (CITATION 3), while 700,000 Americans go bankrupt every year from the cost of their health care bills (CITATION 4). Despite the fact that our treatment abilities are unmatched around the world, we are currently living in a system to where only the wealthiest of those amongst us have access to this luxury. This is where the inherent problem begins, and where government can step in to correct this disaster.
The biggest argument we see in the political arena today is that government is “too big” and that creating both health care reform and a public option would increase the national deficit to even an even higher proportion than what it is today. This is simply not true. Today, the United States currently uses a total of 17.3 percent of its total GDP (Gross Domestic Product) on our current health care system. (CITATION 5).
This means that the United States spends MORE money than any other country on health care in the entire world, including those with public option systems (better known to some of you tea baggers as “socialized medicine”). In fact, data collected from around the world shows that countries with a government run option tend to spend a significantly less amount of money on health care than those who do not. The United States actually spends half of all the money spent on health care globally. (CITATION 6).
In fact, countries who scored higher than the United States on the World Health Organizations report/survey mentioned above in terms of “overall health system performance” continually spend less than we do for high quality health care. (See citation 1 and 6). So, how are these countries providing better quality care for all of their citizens for more than half the price of what we spend here in the United States? How does France, who is number one the WHO report/survey only use 11.1 percent total GDP per year, and the United Kingdom only use 8.3 total GDP per year while we are at a staggering 17.3 percent and providing inferior care? The answer is simple, cost and quality control.
This is where the government of almost all modern western democracy’s stepped in and answered the moral question and decided to appropriate health to everyone rather than those who could afford it. By doing so, government organizations were set up in place to determine both quality control and cost efficiency.
In Britain, the National Institute for Health and Clinical Excellence, (NICE), determines what kind of health care the National Health Service, (NHS), will pay for, and what it will not. For example, is it cost effective for the government run option to spend $54,000 replacing the hip of a 93 year-old woman? Or is it necessary to extend the life of an elderly patient suffering from dementia for an additional two years for $250,000?
As difficult as these questions may seem, there is an interesting difference between the way they are answered here in America and the way they are in the UK. NICE, as a government organization functions in total transparency, meaning whatever they chose to deny or allow is completely public, and applies to everyone across the country. This opens these decisions to both praise and political pressure for reform, which gives citizens a constant say in their health care. While in the United States these questions are typically answered behind closed doors in the private sector by health care companies like Blue Cross Blue Shield and Aetna.
The difference is, if a person is declined a legitimate treatment in the UK, the entire country can go into an uproar for that to change, while in the United States, private health insurance entities reserve the right to deny coverage based on their own qualifications of your plan, (and often times outside of it). This typically comes in a letter to the individual denied, and happens daily, causing no major uproar as that person withers away and dies from a lack of coverage.
In the United States, private health insurance companies use a very revealing term to describe an instance when they have to pay for a customers health coverage. This is deemed “medical loss”. Twenty-cents of every dollar spent by Americans for health coverage is never used for covering customers of major corporations.
In 2007, Gov. Arnold Schwarzenegger of California attempted a health care overhaul of his own, attempting to mandate the for-profit health insurance companies in California to spend 85 cents per dollar instead of the 80 we see nationally on customers. This notion was immediately drowned by the calls of “socialism” and “big government” we are hearing today, and the overhaul never even made it to the California Senate floor. So, this is the fork in the road the United States has found itself to be in recent arguments over health care overhaul. We could follow the way of the European nations in terms of dealing with private insurance companies, or we can provide a more uniquely capitalistic approach with the public option. Here are the two options broken down.
1. The European Response: The common misconception of covering everyone under insurance is that it is “socialism” and that it would deny the “freedoms” and “rights” of Americans. Well, this is true in one aspect if we are to take the European response to the private health insurance industry: you would lose your right to go uninsured. In most European countries and in Japan, it is illegal to not have health insurance. It would be the same approach to car insurance Americans took when they made it illegal to drive the roads without it, accept here, the implications are far greater.
Countries like Germany, France, Belgium, Switzerland and even Japan use the Bismarck model, named after German Chancellor, unifier and father of the Welfare State Otto Von Bismarck, (and is not a system invented by the Nazi’s as popularized by some tea baggers at town hall meetings in 2009). Under this system, private entities are allowed to remain, but not for profit. Insurance companies in these countries, while still private entities like those found in the United States, are barred from making a profit. Instead, the hierarchy of the multiple providers competing in these countries are paid higher wages based on the amount of people they insure.
This provides an incentive for competition, which benefits the consumer as these companies are coming up with more and more ways to cover conditions and medical issues including homeopathic medicine, traditional medicine and even trips to the spa, (with a doctors note of course). Under this system, cost control reigns in the spending the government commits to health care yearly. While people will still pay a co-pay, (around $11 for a routine visit to a general practitioner), roughly 80 percent of that is reimbursed to the people by the government. This means your doctors visit would cost you around $2.20 cents out of your own pocket. The same applies to extended stay visits to the emergency room.
Because the government strictly regulates the prices of certain procedures, visits and stays, and not the private sector, both the people and the government pay more than a fraction of what is spent by U.S. hospitals. Doctors and hospitals are all private entities as well, and because of this, doctors make considerably less than they do in the United States. An average doctor in France will make about $125,000 per year. But doctors and hospitals have advantages in this system they do not see in America. For example, tuition is free in the medical field, therefore doctors do not start their practices after college in the roughly $150,000 of debt we see in America.
Also, medical malpractice suits are rare, an average doctor under this system will pay between $500-$1,800 per year for malpractice insurance, (another rate dictated by the government), a fraction of what an American doctor would pay in just one months payment. Because of this, the Bismarck model has allowed countries to cover 100 percent of their population, while spending a fraction of the GDP the American system requires while still leaving out 46.3 million people.
2. The Capitalist Approach: This approach is uniquely more American, and is coined by the Obama Administration as “The Public Option.” Under the Public Option, Americans can buy into this insurance at a discounted rate, while still being able to opt out and continue to stay with their for-profit insurance companies.
The public option, however, would follow the National Insurance Model seen in Taiwan or South Korea. Every citizen according to their tax bracket would pay into this system via taxes, (whether they opt to be a part of it or not).
The system would provide two important aspects for American consumers that they are currently not receiving today. One, the Public Option under government regulation would require accepting all applicants. Under private insurance, those with preexisting conditions or chronic illness may be denied for coverage and left to fend for themselves out of pocket.
This is important because of the second thing the Public Option would do for Americans. Two, and here is where the capitalism really shines, the government run option would compete for customers with the private insurance companies. This would have two major effects, lowering costs between competitors for plans, and would force private insurance companies to cover more medical issues and no longer deny applicants with preexisting conditions or chronic disease. With this in place, the spending might not be reigned in right away as we would see under a Bismarck model, but the private insurance companies would still exist in the capacity that they are today as profit mechanisms and is the most likely transition we will see in America anytime soon towards reform.
So now that we have broken down these systems, let’s look at how they have affected other countries who have implemented them across the world:
A surprising fact to most would be that the United States is dead last in a study comparing infant mortality rates amongst developed nations. In fact, nations with government run systems are all ahead of the US. (CITATION 7). The United States has 6.8 deaths per 1,000 infants born, while Germany has 3.9, France 3.6, Japan 2.8, and even Canada at 5.3.
Another interesting fact that might surprise most Americans is that America placed 38 in terms of “life expectancy from birth.” The average lifespan of an American to date is 78.2 years, putting us just behind Cuba who’s expectancy is 78.3.
But what about those nations with government run health insurance? Japan: 82.6 years, France: 80.7 years, Canada: 80.7 years, UK: 79.4 years. (CITATION 8). Here is where we get back to the fundamental question that should be weighing on the minds of the supposed fiscal conservatives who oppose health care reform: “How are we spending double, and sometimes triple the amounts of these countries on health care and they are producing better results? Is this data not enough to encourage people to push for reform?”
A lot of this also has to do with environment as well. After all, the United States has the highest casualty rate due to gun violence in the world, (beating out both Iraq and Afghanistan). So how do we properly measure the quality of care? Simple: What is the health expectancy, (before decline from natural aging) of those over 60? Well, the Commonwealth Fund took a survey on this in 2006, and out of 23 countries the United States was tied for dead last, Japan being number one. In France, a person can expect to live in a healthy manor another 20 years and three months, while in America, one can expect an additional 17 years according to the Disability-Adjusted Life Expectancy Survey.
What about long lines?
Another interesting argument we see in America is the dreaded “queue” system found in Canada and the United Kingdom. The queue is essentially a waiting list for care.
But is it really happening in the fashion that we see ridiculed by Sarah Palin and Glenn Beck? Yes, and no.
In Canada, yes it is happening. However, it is not because of the system of government-run health care, it is because of an extreme shortage of doctors. Due to a policy in the 1960′s taken by the government with education, the ratio of doctors to patients is staggeringly low. This system functions so poorly not because of the system itself, but because of the lack of manpower the it maintains. (CITATION 9).
This is an easily correctable mistake in America if we were to take on health care reform. We would simply not take the same steps in education the Canadians did. But what about Britain and France? It is true that they do have a queue system, but for different reasons. The queue is only applied to those who have non-acute or elective procedures that need to be done. For example if a Briton or Frenchmen need a hip replaced, it will take about three months before it happens. This is relatively the same amount of time it would take for the procedure to occur in the United States.
However, if you have a more pressing matter, I believe a doctor from one of these countries can put it best: Dr. Badat of the United Kingdom told Washington Post Foreign Correspondent Thomas Reid “Any suspected cancer, you can see a consultant within two weeks. Any cardiac, we get you to the hospital the same day. If you have chest pain, I send you to a cardiac within the hour.” (CITATION 10).
In fact, two American doctors in a report found on the same citation had this to day about the queue system we hear argued about so readily in American politics: “Primary and preventative care are not rationed, and average waiting times to see a general practitioner are probably no longer than for similar appointments in many parts of the United States.
Even some high-tech services (e.g. radiation therapy for cancer and bone marrow transplantation) are performed at the same rates as in the United States. But waiting times to see consultants for non-urgent problems may be substantial, and 38 percent of patients wait more than four months for elective surgeries.” Now here is where yet another moral question comes in: “Are we willing to wait an additional limited period of time for non-life-threatening care so that those who have both immediate medical and financial issues may receive proper care?” Once this question is answered we can move on from asking these questions, to making their obvious answers a reality.
What are the things that would ensure all Americans equal treatment in the health care system regardless of financial status while reigning in the overwhelming amount of money our GDP expends on health care every year? Lucky for you I made a list.
1. Doctors and college: One thing that has helped reduce the cost of health care in every other country is to reduce the amount of money a doctor makes per year, (I would say between $150,000-$250,000 is still a reasonable amount). But the only way to do that is to make the education system free. That is, the government would need to use the funds absorbed through taxation to fund the education of doctors, especially general practitioners since we are starting to see a shortage. This would provide both an incentive to increase the ratio of doctors per patient while also allowing doctors to leave med school debt free.
2. Doctors fees: Under all government run systems, fee’s for certain procedures are maintained by strict regulation of the government. In other words, Americans pay four times as much as citizens in other countries do for a X-ray (for example) because the cost of this procedure is not set by a private industry seeking profit. A side benefit of this is a new industry that has popped up making MRI machines that are significantly less expensive and selling them to these nations, (from $350,000 on average for a top of the line, and $150,000 for one that does basically the same thing). Because of the strict regulation of fees, doctors will make significantly less than they do today. As bad as that might sound, this is a significant part as to why spending in other countries is significantly less for health care than it is in America.
3. Government run liability insurance: Most government run systems offer doctors malpractice insurance. Because of laws that protect doctors from frivolous lawsuits, the rates are significantly reduced. (A doctor in Britain for example will pay a third per year for insurance of an American doctors one month payment). This is important because it will assist the doctors in their overall spending. Innovations cannot be made in this country if doctors are paying two-thirds or more of their paycheck for fear of being sued. One of the more relevant issues today with these frivolous lawsuits is that they are being over hyped. In fact, medical malpractice lawsuits only make up one percent of everything spent in America on health care, so there is a significant need for reduction of price for doctors.
4. Government health care regulation agency: The most vital part of this entire system is a government institution which will decide which drugs, procedures and innovations will be covered by a government run insurance plan. This system will equally rely upon its transparency to the American people. When a decision is made, it must span across the entire population who opts into this system. Therefore, political pressure will can be constantly used to reform and modernize this decision making process. To really grasp this one needs to understand that this decision making process is already being made on a daily basis with no transparency by companies who seek to fill their bottom line with profits and deem paying out insurance claims as “medical loss”. The great thing about this is the stopping of defensive medicine. The organization will make countless studies to determine the viability of certain procedures with various conditions, which in turn will provide a safer system while at the same time eliminating procedures that do not work with certain cases. This in itself will save an absorbent amount of money for the tax payer, the system and the doctors.
5. A government-run health care system: This system is what we have been talking about all along and will embody the four previous goals and the next to come. The system will be available to everyone, not just those who can afford it, regardless of preexisting condition, health status, etc. With this system in place the American people stand to reduce the total GDP spent per year on health care, while maintaining the right to “life” as Jefferson declared “inalienable” which we do not see under the present system of selective exclusion. With this, we can create a better product for the American people while still maintaining a fiscally responsible system.
6. Incentives for healing for doctors: In the United Kingdom, doctors can earn twice their salary for simply practicing preventative medicine. Doctors in the UK, for example, get $6 per flu shot they give to their patients. Another such example is doctors will be paid an additional fee for checking the extremities of diabetes patients for abnormalities. This type of reward provides incentive for doctors to provide the best care they can, because, well, they are getting paid to do so. In turn, potential major issues are caught early in these tests and both this increases the survivability rate of the patient and reduces the cost for the system for treating something far more advanced requiring harsher methods of medical response. This system speaks for itself in the benefits it could provide for both patients and the economical value it maintains in saving the system from being overburdened with advanced cases of illness requiring more expensive treatment.
7. Dismantle Medicare, Medicate, SCHIP, etc: Single payer systems tend to save a lot of money because of the lack of the need for administrative costs. The United States doctor is burdened with thousands of different payment options, leaving a small clinic of 1-2 doctors and a nurse with eight people working in the billing department. This is a huge portion of the cost of American medicine. In France, doctors work with one card, and one system, which once its billed has to by law pay the fee. This means there is no need to hire administrative assistance to deal with claims, deferrals, denial of coverage or chasing down out of pocket expenders. Liquidate all government run options and formulate them under the one public option to minimize the amount of paper work and professional knowledge needed to collect payment. Doing so would be just another way to save the system money, therefore freeing up funds to treat patients.
8. Create paperless medical records: In France, doctor offices have the same basic look as they do in America, with one giant difference: No file cabinets. Why? Because the French have created the Carde Vitale, or “vital card”. This is an encoded card similar to a drivers license issued to every French citizen. Inside it is a microchip which carries all the medical records of the card owner from birth. With this great step in technological ingenuity, two important things have happened. One, if a person is incapacitated by an accident, say a car crash, the responding paramedic need only look in the citizens pocket and swipe the card. From there, transfusions can begin on site if a person has lost a lot of blood, or specific medications or revival methods could be withheld due to allergies that could only complicate the issue. Two, doctors, like I said before, have no need to pay administrative fees. You simply bring your card and they swipe it, and know everything about you. No more paying receptionists to fax records from one office to another, or using the tons upon tons of paper needed to maintain records. This also, incidentally does two great things for the consumer. One, it reduces wait times, as there is no one trying to dig your records from a file. And two, it allows you to see any doctor in France without the worry of lugging documents along or having them faxed over before you can see a general practitioner. This undoubtedly has saved billions, and would be yet another way to promote a fiscally responsible health care reform effort.
9. Kill generic drugs: Frustrating to most Americans I’m sure is the fact the overall cost of drugs in this country. Even more frustrating is the fact that we can pay up to 3000 percent more for drugs selling in other countries for pennies that come from the same factory. Well, a lot of it has to do with a program implemented in America designed to alleviate the cost of drugs: Generics. The reason why the American public takes such a large sum of the cost of drugs in compared to the rest of the world is because of this: In the U.S. a drug company will attempt produce anywhere between 100-150 drugs per year for market.
These drugs will cost literally billions in research and development, and only one or two per year will pass the Food and Drug Administrations (FDA) strict regulation policies and hit the market. Now, here is where generics come in. Generics are drugs produced without patent. They are typically created by smaller drug companies outside of the United States after the patent for the original drug created here has expired. These drugs will sell at a significantly reduced price and are required by the FDA to contain the original formula made in the original drug it is seeking to copy.
So here is where the problem beings. Out of those 100-150 drugs, only one or two makes it to market under patent. This means American drug companies have anywhere between 6-10 years (depending on the patent) before the drug can be copied by generic companies outside the US and sold for a cheaper price. Plus, often times, insurance companies will only pay for the generic version once they come to market, effectively killing the market for the original maker. So basically, drug companies in the United States have 6-10 years to make up for the billions of dollars in lost research for 98-148 drugs that never made it past the FDA with the two drugs that did. This is why the cost of drugs is so inflated and has made it so difficult for people to afford them without insurance.
This is why the sick stay sick even after they shell out thousands for the doctors visits. The reason why European markets are paying less for the drugs is another reason why drugs in America are so expensive. With strict regulation on pricing by foreign governments, American companies are forced to push most of the expense for research and development on American consumers, who’s government does not regulate the prices, (at least not to the extent of other Democracies). By ridding ourselves of foreign generics, this would free the drug companies tight squeeze on costs, allowing them to reach maximum return for break-through drugs over a longer period of time instead of racing for profits as they are doing now.
With all these steps in place, we can create a more responsible, moral and fiscally reasonable health care system that would benefit everyone. We could soon join the ranks of citizens of other countries who never have to worry about going bankrupt from illness or injury, and we can create a quality of care which promotes the guarantee of “life” through a process of equality and fairness. Thomas Jefferson foresaw the dangers of the banking system in relation to the greed of the human perspective, and we are seeing the same influence of money grabbing in todays health care policies.
We can make a decision, a moral one, make everyone equal under law with their unalienable right to life; or we can continue upon the status quo, and leave 46.6 million Americans one step away from bankruptcy simply for getting ill, or having an accident. The choice is yours, and now, armed with this information, you can simply do nothing, or you can work together as a people to better yourselves, and the lives of those less fortunate. John Kerry, I think, said it best: “The problems of health care can be solved if we stop giving tax cuts to those who have the most, and start making health care affordable for those working harder and harder for too little.”
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