- The Washington Times - Saturday, September 18, 2004

Media reports our health-care system is “broken” and “threatened with meltdown” are hardly surprising in view of costs soaring fivefold the rate of inflation and with 45 million Americans uninsured for medical care.

More than a century after Germany’s Chancellor Otto von Bismarck introduced universal health insurance (UHI) to the civilized world to combat communist political inroads, the richest and most powerful nation remains unique in not providing all its citizens what the people of other Western industrialized societies have enjoyed for decades — the assurance economic considerations are not paramount at a time of an illness or accident.

We pay heavily for the failure of our health-care socioeconomics to keep pace with the brilliant advances of our medical science and technology. The prestigious National Institute of Medicine estimates this health-care enigma results in 18,000 preventable deaths yearly (6 times the mortality of September 11, 2001) and an economic loss of $65 billion to $130 billion from these early deaths.

Neither presidential candidate in this election, however, have offered a workable solution to our health care dilemmas.

Health care has never been high on President Bush’s agenda. While he was governor, 24 percent of Texas’ population was medically uninsured — the highest percentage of the 50 states.

Now Mr. Bush promises to “build on the health-care reforms we’ve started ” and “on the successes” of his first term. The cost of this building program would be a modest $89 billion.

A review of his claimed successes indicates the president will be building on a shaky foundation indeed. In his first term, Americans without health care insurance increased by 4 million and continue increasing 100,000 monthly.

Mr. Bush has restricted stem-cell research, to the dismay of the scientific community and Nancy Reagan. He has advocated a reversal of Roe vs. Wade, which would result in the poor giving birth to at least 500,000 unwanted babies yearly and a multibillion increase in health-care and social costs. And his answer to escalating health insurance premiums was medical savings accounts, which fortunately have gone nowhere, as this regressive concept would shelter taxable income for the affluent in higher brackets.

Perhaps Mr. Bush’s most unfortunate “success” was his Medicare reform bill that eliminated negotiation of prescription drug prices with the pharmaceutical industry. Thus, the American Association of Retired Persons (AARP) — 35 million strong — was denied the advantage of bargaining through bulk purchases. Imagine the uproar in the corporate world if Hertz was prevented, by law, from realizing hefty discounts by purchasing autos in large lots.

Sen. John Kerry’s health-care-reform package suffers from not presenting the voters a simple, comprehensible program that narrowly focuses on the most salient problems of our system — skyrocketing costs and a huge medically uninsured population. His Web site spells out, in nine pages, health-care reforms that would “harness American ingenuity” to cure a large assortment of health care problems.

Mr. Kerry tackles medical-care quality with a new “Quality Bonus Award” and addresses medical malpractice; meritless lawsuits, medical errors, medical bureaucracy and paper work, waste, fraud and abuse. He also favors involvement in actual medical practice by disseminating disease prevention information, promoting exercise and even fighting obesity.

It smacks a bit of Clinton’s ill-fated Health Security Act that tried to correct all of medicine’s deficiencies in a single session of Congress — a bill that aroused so much furor it never came to a vote. Moreover, the $653 billion estimated cost of Mr. Kerry’s health-care program is sure to be resisted stiffly by a Congress facing an projected $2.3 trillion federal deficit in the next 10 years.

Of overarching importance, neither Mr. Bush nor Mr. Kerry has addressed the basic anomaly of our health care system. That is funding by a multipayer, employer-based private insurance industry with the business atmosphere of competition, marketing, stockholders, bottom lines and huge executive salaries. These costs drive up health-care overhead 10 to 25 percent ($160 billion to $300 billion) yearly — that does not contribute to the cure of a single patient.

This outmoded funding method is rooted in the wage-and-price controls of World War II. The labor shortages of the time could not be resolved by offering higher wages due to War Labor Board regulations, and workers were enticed by benefits such as health insurance completely paid by employers.

National health costs in those days totaled less than $40 billion yearly — less than 5 percent of gross domestic product (GDP).

This anachronistic funding mechanism has been overtaken by time and events. Total health care costs have escalated to $1.6 trillion yearly and 14.9 percent of GDP — almost double that of other Western democracies — and projected to reach 17 percent when the Baby Boomers become eligible for Medicare in 10 years.

The answer to our profit-driven health care industry is universal health insurance (UHI) financed by a nonprofit, single-payer government agency. In short, Medicare for our entire population. This health-care program operates with an overhead of less than 5 percent and is well-accepted by the elderly.

We do not have to look far. Canada’s single-payer government-funded health-care system provides UHI with quality care equal to ours at a far lower cost — 9.6 percent of GDP.

Canada’s decentralized health care system is delivered with the guiding principles of accessibility, universality and portability. Funding is prepaid through tax dollars without additional charges at point of service. Ninety-five percent of the hospitals are privately owned, physicians practice on a fee-for-service basis and patients have a free choice of doctors.

The overwhelming majority of Canadians have “strong attachment to the principles of their health care system,” and they would be “deeply discomforted” with any system limiting access because of inability to pay. A Harris poll of industrial nations indicated Canada ranks highest and the U.S. lowest in patient satisfaction.

All the important features of Mr. Kerry’s comprehensive health-care plan are incorporated in the Canadian system — universal coverage, electronic records and billing, 40 percent to 60 percent lower prescription drug prices through negotiation and appreciably lower administrative costs.

Importantly, the Canadian system provides for global budgeting, without which Professor Eli Ginsberg of Columbia University, the dean of American health care economists, flatly asserts health care cost control is “impossible.” Of course, if the buyer of any service or commodity has a voice in the price, costs are lowered whether buying apples or appendectomies.

Finally, authoritative studies indicate changing to a Canadian-type health-care system, which manages to function without stockholders and multimillion-dollar executive salaries, would save enough to lower health-care costs and fully insure all Americans without increasing the federal deficit.

It would be ludicrous to claim Canada has no health-care problems. But the most important — long waits for care because of a shortage of hospital beds, medical personnel and advanced diagnostic techniques — would not apply in the U.S.

Medical personnel here are plentiful, there are many hospitals and we are among medical technology’s world leaders.

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

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