Tuesday, September 28, 2004

It’s not surprising that the nation’s ongoing health care reform debate has prompted some commentators to argue for a government-run, single-payer health care system. But those who do so fail to address the most pressing issue that stands in the way of real reform: a lack of consensus among Americans on what we want from our health care system.

Critics of the present system often point to government-run systems in Canada, Britain and elsewhere as models of enlightened organization, delivery and outcomes. But there’s a big gap between theoretical models and facts on the ground.

A survey by the federal Center for Disease Control and Prevention shows, for instance, that Americans have a higher level of satisfaction with their health care services than Canadians do with theirs. One reason can be found in outcomes research showing that Canadians have a greater risk of dying within five years after suffering a common type of heart attack — a difference in quality of care that translates into thousands of lives lost needlessly each year.

Canadian lawmakers, meanwhile, have been struggling with how to finance their system’s unexpectedly high costs — some of which can’t be measured in dollars and cents alone. The Fraser Institute found, for example, that patients in Canada typically must wait nearly four months from initial diagnosis to treatment by a specialist.

And it’s not just patients who are poorly served by Canada’s flawed system of care. As the Canadian Institute for Health Information has noted, many Canadian physicians are leaving for the United States, fed up with rationing and inflexible government controls.

How does our present system measure up to a government-run system? A study by the National Center for Policy Analysis compared America’s private health care model to Britain’s government-run National Health Service. The study found that U.S. health insurance plans “achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition and greater investment in information technology.”

Some commentators cite high cost as an obstacle to reform given the projected budget shortfall facing Congress over the next ten years. Yet the cost of market-based reform pales in comparison to the costs associated with a government takeover of our health care system.

Many studies have shown that a government takeover would require significant tax increases to fund a centralized bureaucracy — one which would inevitably make it harder for patients to make their own choices. Not surprisingly, a survey of likely voters in 17 presidential “battleground” states found that they overwhelmingly prefer a public-private partnership, with a choice of private health insurance plans coupled with a public safety net for those unable to afford health coverage.

We can all agree that reform is needed. But, as many voters understand, simplistic one-size-fits-all solutions just won’t get us there. Our primary goal should be to provide consumers — those with and without health insurance — with a choice of affordable, quality care options best suited for their particular needs.

There are many incremental steps that we can take in that direction, such as reforming America’s medical liability system, lessening the burden of government mandates, ensuring that health care is based on the best scientific evidence and providing tax-free health care accounts. All will help promote greater competition, improve quality, and make care more affordable. All, in short, are keys to successful reform.

To illustrate, our members have offered specific policy proposals to meet the diverse needs of the uninsured population, including providing tax credits for 15 million lower-income families and individuals; creating high-risk purchasing pools to cover a million uninsured individuals with especially high health care costs; intensifying efforts to enroll about 9 million eligible Americans in Medicaid and other government assistance programs; and providing an estimated 2 million Americans living near poverty with access through public financing of private health coverage.

Each time we implement one of these policies, we move one step closer to our goal of providing coverage access to millions of Americans without health insurance. And — key point — we fix what’s wrong with our present system without undermining what’s right with it.

It’s always tempting to look for a quick fix. But it’s also dangerous. When we carefully consider what we really want from our complex health care system, we’ll see that we’re better off focusing on reasonable and effective solutions that preserve and improve access to affordable, high-quality care without infringing on individual choice.

Karen Ignagni is president and CEO of America’s Health Insurance Plans.

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