Simple health care remedy

OPINION:

It has been more than a century since Imperial Germany’s Chancellor Otto von Bismarck introduced universal health insurance to the civilized world to combat the inroads of communism. Yet the richest and most powerful nation in the world remains unique in not providing all its citizens with what the people of the other industrialized nations have enjoyed for decades — the assurance that economic considerations will not be paramount at the time of illness or accident.

The rationale for universal health insurance (UHI) is not complicated. Due to the unanticipated nature of disease or accident, the answer to preventing a medical calamity from becoming a financial catastrophe is budgeting in advance through insurance as we do for a possible house fire or auto accident.

But the triumphs of modern medicine are marred by the failure of our health-care socioeconomics to keep pace with the brilliant advances of our science and technology. Some 47 million Americans lack health insurance — an increase of 5 million since President Bush assumed office.

Further adding to our “broken” health-care system, medical costs are soaring 4 times faster than wages. Total health-care spending now exceeds $2 trillion annually — almost 17 percent of the gross national product (GDP), nearly twice the ratio of the other industrialized societies and projected to climb to $4 trillion, 20 percent of the GDP, by 2015. Federal Board Reserve Chairman Ben Bernanke has warned that a financial crisis looms due to these unsustainable health-care expenses.

Presidential hopeful Sen. Hillary Clinton has now weighed in with a plan to revamp our failing health-care system. In doing so, she repeatedly assures us she has “learned from the mistakes” she made in her ill-fated attempt to reorganize the entire health-care system during her husband’s administration. Further, she insists her plan is “not run by the government,” and thus would not perpetuate the “socialized medicine” scare of the private, employer-based health-care industry that conned the public and Congress and scuttled the Clinton reform plan of the 1990s.

By maintaining the private health-care industry, geared for profit rather than the public good, as the funding mainstay of her new plan, Mrs. Clinton continues to promote the principle cause of skyrocketing health-care costs — the business atmosphere of marketing, advertising, stockholders, bottom lines and huge executive salaries, none of which cures a single patient and operates with 3 to 4 times the overhead of “government run” Medicare.

Illustrating Winston Churchill’s admonition, “The thing we learn from history is that we don’t learn from history,” Mrs. Clinton’s health-care plan is a bureaucratic nightmare rivaling her 1993 fiasco. Her plan includes complex funding methods and tax credits for businesses depending on how many employees they have and premiums varying with income for individuals not covered at work. The less affluent would receive tax credits tied to their poverty rating.

But not to worry. Mrs. Clinton’s health-care mishmash is far too undigestible for the current crop of Washington legislators, who remind one of President Truman’s “do nothing” Congress.

Ideal health care reform begins with a delineation of its minimal requirements:

• Affordability — ability to pay is not a factor.

• Accessibility — easily available whether for routine or emergency care.

• Universality — universal health insurance is mandatory.

• Portability — coverage is not affected by changing jobs.

These sine qua non are almost completely lacking in our present health care system.

The answer to our profit-oriented, private health insurance industry (an anachronism held over from World War II ) is a single-payer government-sponsored agency similar to those in the other industrial nations with health-care costs roughly half of ours. In short, Medicare for our entire population, like workman’s compensation, which is the law in all 50 states.

Society demands universal health insurance for breadwinners injured on the job but not if they suffer the same injury while driving home from work. Why should a 5 o’clock whistle determine whether medical expenses are covered?

The quickest, easiest and cheapest way of developing universal health insurance would be adoption, with modifications, of Canada’s health-care system, which boasts a quality of care equal to ours at far lower cost.

It was not always so. In 1971, the ratio of total health-care costs to GDP was 7.1 percent in Canada and 7.6 percent in the United States. With the adoption of the single-payer health- care system, Canada’s ratio rose to 9.6 percent in 2006 while ours increased to 16 percent.

Briefly, Canada’s health-care system provides one standard of care for the entire population, rich and poor alike. There are no additional payments (deductibles or co-payments) at the time of treatment. The principals of the system are set by the central government, but the funding, as well as the administration, are chiefly the domain of the provinces. Medical payments are prepaid and taken from income taxes without an additional bureaucracy.

The Canadians overwhelmingly have a strong attachment to their health-care system and are “deeply discomforted” by any system that limits access because of inability to pay. Canada’s new government suggested some privatization of the system as in the United States, but the backlash was so violent that the idea was quickly dropped.

During the 1990s, Taiwan, after carefully studying health-care systems abroad, opted for the Canadian system with excellent results.

The Lewin Group, prestigious analysts of medical socioeconomics, have confirmed that changing to the Canadian health-care system would result in an appreciable monetary savings.

The major criticism of Canada’s health-care system is the occasional delays in diagnosis and care. This would be less of a problem in the United States where diagnostic facilities are in far greater supply than in Canada.

To my critics who find my solution to our health-care woes “simplistic,” I can only plead my surgical background. Always perform the simplest operation that results in a satisfactory medical outcome.

Alex Gerber, M.D., is a clinical professor of surgery, emeritus, at the University of Southern California and a former health-care consultant to the U.S. Health and Human Services Department.