Americans understand something that the political classes are just beginning to take seriously: America's health care system is dysfunctional.
As a poll of 1,281 Americans conducted in February and issued in March by CBS News and the New York Times, about nine in 10 say "the system needs at least fundamental changes, including 36% who favor a complete overhaul."
Much of the concern, according to the poll, is due to cost. Most people say "they are generally satisfied with the quality of their own health care, including 41% who say they are very satisfied," but only "one in five are very satisfied with what they pay for health care, while a majority (52%) are dissatisfied, including a third who are very dissatisfied."
A report issued in May by the Commonwealth Fund, a non-profit group that studies health care, offered a glimpse into where the dissatisfaction comes from. The report, which studied health care in Germany, Great Britain, Australia, New Zealand and Canada, found that all five "provide better care for less money," according to Reuters. The US system "ranks last . on measures of quality, access, efficiency, equity and outcomes," the non-profit group said.
"The United States is not getting value for the money that is spent on health care," Commonwealth Fund president Karen Davis told Reuters.
That seems pretty obvious, though Congress has made little effort to do more than nibble at the edges since the failure of the Clinton health care plan more than a decade ago.
Congress, President Bush, many employers and insurers have all agreed in recent months to overhaul the US health-care system -- an uncoordinated conglomeration of employer-funded care, private health insurance and government programs.
Despite spending about two times per capita what the other countries studied spend -- $6,102 for the US in 2004, compared with $3,005 for Germany, $3,165 for Canada, $2,083 for New Zealand, $2,876 for Australia and $2,546 for Great Britain -- there are about 45 million Americans with no insurance.
And this disparity is likely to get worse, unless we change the way we manage our health-care system.
American Medical Student Association fellow Kao-Ping Chua wrote in a position paper called "The Case for Universal Health Care" that skyrocketing costs has increased the number of uninsured and underinsured Americans.
"In the face of rising health care costs," she wrote, "fewer employers are able to provide their workers with health insurance; the percentage of employers offering health insurance dropped from 69% in 2000 to 60% in 2005. Even if employers are able to provide health insurance benefits, the trend is towards providing high-deductible insurance that covers an ever-shrinking percentage of health care costs. The net result is that more and more employed middle-class Americans find themselves with low-quality or no access to health care."
Medicaid has traditionally served as the safety net for those without health insurance, but the program "has recently been the subject of relentless funding cuts by cash-strapped states and Congressional representatives who are ideologically opposed to welfare programs" leaving a program that "will not be able to offset the losses in employer-based insurance, resulting in more and more uninsured individuals."
The answer, Chua writes, is universal health insurance, which would streamline the system and open it up to all, regardless of their ability to pay.
"The United States is the only industrialized nation that does not have some form of universal health care (defined as a basic guarantee of health care to all of its citizens)," Chua writes. "While other countries have declared health care to be a basic right, the United States treats health care as a privilege, only available to those who can afford it. In this sense, health care in America is treated as an economic good like a TV or VCR, not as a social or public good."
Chua makes three basic cases for universal coverage: moral, economic and cultural, with all three being tied together. Morally, Chua writes, a for-profit health care creates a multi-tiered system in which the poor are sicker and die younger, the middle class remain an illness away from bankruptcy and on the "truly rich" are protected.
Economically, the lack of care lead to bigger costs down the road, including lost work productivity and excessive emergency room use. Culturally, the broken health care system places a strain on democratic institutions, furthering the great inequalities that exist both economically and politically in the United States.
Universal health care levels the playing field in this regard, while addressing the economic issues and ensuring that all Americans can get not only emergency care but regular preventative care, as well.
Hank Kalet is a poet and managing editor of the South Brunswick Post and The Cranbury Press in central New Jersey. Email firstname.lastname@example.org. See his blog, Channel Surfing, at www.kaletblog.com.
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