In addition, burgeoning satellite businesses, such as
consulting firms and marketing companies, consume an
increasing fraction of the health care dollar. We endorse
a fundamental change in America's health care. The
creation of a comprehensive national health insurance
program, or NHI. Such a program which, in essence,
would be an expanded and improved version of Medicare,
would cover every American for all necessary medical
care. Most hospitals and clinics would remain privately
owned and operated, receiving a budget from the NHI to
cover all operating costs. Investor owned facilities
would be converted to not-for-profit status and
their former owners compensated for ...view middle of the document...
It would squeeze out bureaucratic
waste and eliminate the perverse incentives that
threaten the quality of care and the ethical
foundations of medicine.
Now I'd like to take a few minutes to expand on
some of the points in the summary I just read and, in
particular, to respond to some of the arguments often
made against a national health insurance program.
As stated in the summary, Americans have the most
expensive health care system in the world. We
spend on average twice as much per person as other
developed nations, and that gap is growing. That's
not because we're sicker or more demanding. Canadians,
for example, see their doctors more often than we
do and spend more time in the hospital. And it's not
because we get better results. By the usual measures
of health, life expectancy, infant mortality,
immunization rates, we do worse than most
other developed countries.
Furthermore, we're the only developed nation that
does not provide comprehensive health care to all
its citizens. Over 42 million Americans are uninsured
disproportionately, the sick, the poor and minorities.
And most of the rest of us are underinsured, even
while we sometimes receive far more of certain kinds
of health care than we need.
In sum, our health care system is outrageously
expensive, yet inadequate and inequitable. Why?
The only plausible explanation is that there's something
about our system, about the way we finance and
deliver health care, that's enormously inefficient.
We simply don't get our moneys worth. In my view, and
that of many other critics of our system, the underlying
problem is that we treat health care like a market
commodity instead of a social service.
UNIDENTIFIED MAN: There you go.
DR. ANGELL: Health care is targeted, not to
medical need, but to the ability to pay. Now markets
are good for many things, but they're not a
good way to distribute health care. Let's look for a
moment at how the health care market really works.
Most Americans receive tax free health benefits from
the employers who pay insurers a portion of the premiums,
but not all employers offer benefits. It's strictly
voluntary. And when they do, the benefits may not
be comprehensive. Higher salaried workers are more
likely to be covered and the coverage is better. About
one in five workers, mainly those with low salaries,
turn down health benefits because they can't afford to pay
their share of the premiums.
The insurance companies with whom employers do business
are mostly investor-owned, for profit businesses,
that first appeared on the scene 10 to 20 years ago
when the managed care market opened up. They tried to
keep premiums down and profits up by stinting on medical
services. In fact, the best way for insurers to
compete is by not insuring high risk patients at all;
limiting the coverage of those they do insure, for
example, by excluding expensive services such as...