Health care for all

April 29, 2003|By Neil Solomon

ABOUT 42 million Americans - 600,000 in Maryland - have no health insurance, either because they have no jobs or jobs with no health benefits, they can't afford it, or they don't think they need it.

Nationally, the number is increasing by about 1 million annually.

Citizens can bring these figures to zero by voting into office leaders who will enact national health insurance.

We know that our health insurance is only as good as our economy and job. The Robert Wood Johnson Foundation recently reported that sometime during 2001 and 2002, 30 percent of 74.7 million Americans under 65 were uninsured. Sixty-five percent of them were without health coverage for at least six months, and 24 percent were uninsured throughout those two years.

Ron Pollack, executive director of Families USA, said, "The findings in this report should represent a sea change in the way we think about the uninsured. Now that almost one out of three non-elderly Americans experienced significant periods without health insurance, the uninsured problem is no longer simply an issue of altruism about other people, but it is also one of self-interest for us all. ... We are moving toward a political tipping point that will require real and meaningful action to expand health coverage."

Frank Bailey, Maryland's director of the AARP, said its policy is now in favor of health coverage for all citizens and AARP believes "it's needed and doable after our economy improves."

States are running deficits totaling about $67.5 billion this year and projected to be $85 billion next year. Medicaid expenditures represent about 20 percent of states' total budgets. According to Families USA, cutbacks could jeopardize "the health care of 47 million low-income seniors, people with disabilities and low-income children and their parents."

To prime the national health insurance pump, let's discuss redirecting President Bush's hundreds of billions of dollars of proposed tax cuts over the next 10 years, which mostly benefit people with high incomes. Put it back into the economy as a down payment on universal coverage.

A privately administered national health insurance plan would include current Medicare coverage plus prescriptions, disease prevention, mental health parity and illness and injuries arising from terrorist attacks. It would also take into account the baby boomers, who will double the Medicare rolls from 40 to 80 million over the next 30 years.

Yes, it would be expensive, costing perhaps more than $2 trillion a year. To succeed, you and I must commit to pay for it. Pool all health spending and reduce the excessive 40 percent administrative costs and profits of some private health insurance plans to help fund the uninsured. People satisfied with their current health insurance could keep it.

This is neither socialized medicine nor the Canadian plan. It's the "USA Plan," where affordable, quality health care with freedom of choice is a basic right for every citizen.

National health insurance would create an honest, inclusive working partnership among providers, payers and patients that would result in continuity of care, stable integrated delivery teams and affordable health insurance. Its rules wouldn't keep changing.

The managed care cost-cutting pendulum has swung too far to the right. No longer emphasizing patient care, it now focuses on managing dollars for so-called savings.

This is accomplished by hiding health care rationing under the canopy of managed care. The discipline of managed care could be useful under a national health insurance umbrella that sets firm, but fair, budgetary limits for everyone. In 2001, Maryland's health expenditures jumped 11.8 percent, the federal government reported that U.S. health care soared to $1.42 trillion (14.1 percent of the gross domestic product), and private health insurance premiums rose 10.5 percent.

As costs increase, access decreases. Voluntary health insurance through employers, laced with stopgap, patchwork measures, isn't working. It's only going to get worse as employers get pinched economically and pass on greater health costs to employees in the form of higher premiums, deductibles and co-payments. Government will do the same. People will continue to pay more and get less.

Unpaid medical bills are the leading cause of personal bankruptcy in the United States. We must untangle and reconfigure our priorities to fund national health insurance through fair taxation according to our ability to pay.

Neil Solomon, a medical doctor, is a former Maryland state secretary of health and mental hygiene.

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