Bleak health-care future

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By Alex Gerber, M.D.

Health-care costs soaring 4 times faster than wages are further weakening our economy, and these costs are expected to double by 2017. Fed Chairman Ben Bernanke has warned that a financial crisis looms due to these unsustainable economic factors.

Unique in the world, we do not provide the universal health insurance (UHI) that other industrial societies have enjoyed for generations — the assurance that economic considerations will not be paramount at the time of disease or accident.

Indeed, more than 47 million Americans lack any health insurance at all — an increase of 6 million on President Bush's watch. The nominees for president in November, Sens. Hillary Clinton, Barack Obama and John McCain are well aware of these facts and have proposed plans to overcome the fiscal shortcomings of our health-care system.

Since the top health-care economists in the nation are available to the White House, we should assume our health-care woes will be largely resolved upon the retirement of a president with the lowest approval rating in our history.

A careful review of the health-care reforms offered by those who would become our next president depicts a gloomier picture.

• Mrs. Clinton's plan is a bureaucratic nightmare rivaling her 1993-94 fiasco and continues to promote the main cause of health-care costs nearly double that of all other countries — the for-profit, private health insurance industry. Her plan is a mish-mash of complex funding methods including mandates, subsidies, tax rebates and various premiums adjusted to income and poverty class rating. The plan is unprecedented and is similar in many respects to Gov. Arnold Schwarzenegger's health-care plan for California, which died in a State Senate committee. The $110 yearly tab of Clinton plan is based on a "lot of assumptions" and leaves "a lot of margin for error" according to Mrs. Clinton's own health-care advisers.

• Mr. Obama's health-care plan is similar to Mrs. Clinton's in many respects but less costly — $65 billion per year after "putting efficiencies" in place that are not spelled out. Moreover, his plan does not provide for universal health insurance — the sine qua non of any new health-care plan. In promising during his campaign to not only "change Washington" but "change the world" he ignores how unknown he is and how little influence he has abroad.

• Mr. McCain has recently weighed in with a health-care plan that completely eliminates "big government" with its "inefficiency, irrationality and uncontrollable costs" from any role in lowering health-care costs and depends instead on the "market place" — individual choice of plans and the private health-care industry. Medicare, the most progressive medical legislation of the last century would thus be eliminated with the end of "big government." His plan is similar to one proposed by President Bush in his 2007 State of the Union address that failed to even get a committee hearing.

So, not to worry. The Clinton, Obama and McCain health-care plans are far too complicated to ever see the light of ray.

The quickest, easiest way to straighten out our "broken health-care" system would be to adopt a modified Canadian system. The quality of care equals ours at far lower cost: Medicare for all age groups.

One statistic is relevant. In 1971, the ratio of health-care costs to federal gross domestic product (GDP) was 7.1 percent in Canada and 7.6 percent in the United States. But since adopting a single-payer plan that year, Canada's ratio has risen slightly to 9.6 percent while ours has approached 17 percent. Taiwan has maintained low health-care costs by adopting Canada's single-payer system.

In sum, none of the presidential hopefuls have come to grips with our skyrocketing health-care costs. If there are not drastic changes in the health-care scene, America is in for a rude awakening in 2009.

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