It’s been a while since I’ve put a worthwhile piece of on my blog. This one is a bit long and detailed, and thus has taken me a while to really get it finished. Though I generally consider myself more conservative, this is something that is not a right-wing/left-wing issue anymore. I like my personal rights, my firearms and the idea that less is more when it comes to most government issues. However, this is a bipartisan issue that must be addressed… soon.
Through my experience in medicine, I have been lucky (or unlucky, depending on how you view it) to see a wide-variety of the population in and out of many aspects of the healthcare system. Given my interest in emergency medicine, I will admit I am a bit biased in seeing how many people are forced to turn to the emergency department for care. The ED is the one place anyone can turn to for healthcare, even if the issue they are coming in for is not what most would deem is a true “emergency.”
As our former president put it, “I mean, people have access to healthcare in America… After all, you just go to an emergency room.” (George W. Bush, Cleveland, Ohio, 10 July 2007)
So what? Why is this important?
- Almost 46 million Americans were uninsured as of 2007. 46 MILLION! That amounts to almost 1 in 6 people in the richest country in the world that don’t have healthcare insurance.[i]
- The number one cause of individual bankruptcy is medical bills.[ii]
- Being uninsured increases the risks of many major illnesses and death. The odds of suffering a stroke are nearly 3-fold when comparing the uninsured to those with continuous coverage.[iii] The odds of death are 1.6-fold higher for people aged 55-65 when comparing the insured to the uninsured.[iv]
- Having a single-payer system would separate healthcare coverage from employment. This would increase portability and allow for continued healthcare coverage when between jobs. In turn, the incredibly high rates of COBRA coverage would no longer be a concern when between jobs. Additionally, this would allow those that fall ill while working from losing coverage while recovering from illness.
- We are the only industrialized country in the world without some form of universal healthcare. We are one of three OECD analyzed countries without universal healthcare; the other two being Turkey and Mexico.[v]
Nothing makes for more interesting writing than what USA Today calls the “cocktail taboos”: Religion, sex, politics. In light of some conversations I’ve had with other both medical and non-medical people I would like to address the top 10 arguments against universal healthcare (UHC) I hear most often.
Top 10 Myths of a Single-Payer Healthcare Plan:
1 – “I don’t want to have to wait to see my doctor or get surgery I need”
The median wait time to get an elective CT or MRI was less than 4 weeks. Greater than 86% were able to get their elective imaging done in less than 3 months. The median wait time to see a specialist physician was just over four weeks, with 89.5% seeing them in less than 3 months. The median wait time for elective surgery was less than four weeks, with 82.2% receiving it in less than 3 months. The average wait time for a total hip was less than four weeks.[vi] By comparison, the average wait time to see a specialist with Medicaid coverage was greater than 3 months.[vii]
Additionally, a Commonwealth study that was done in 2005 demonstrated that 47% of sick adults were unable to get same-day or next-day appoints here in the US. We ranked second to last.[viii]
2 – “The Canadian Healthcare system is expensive compared to the US”
The US government spends more on healthcare than on Social Security and the Depart of Defense combined.[ix] In 2006 we spend almost 16% of our GDP on healthcare, in comparison, Canada spent only 10.1%. Additionally, Canada’s total healthcare costs per capita were approximately 53% of what the per capita cost was in the US in 2007.[x]
3 – “Healthcare in the US is of higher quality than in Canada”
Our healthcare, by almost all measures ranks very poorly compared to other industrialized countries of the world. In fact, in most areas our healthcare system essentially sucks. A 2007 study comparing the US healthcare to Germany, Canada, UK, Australia and New Zealand, we ranked last or next to last in quality, access, efficiency, equity and outcomes. The only place we consistently ranked number one was in cost. It is also worth nothing that we were the only country in that study lacking universal healthcare.[xi] Our infant mortality rates are worse than every industrialized country with universal healthcare. Cuba out ranks us and we just barely beat Croatia![xii] We rank 50th in life expectancy, behind Portugal and just above Albania.[xiii] We rank 37th (way behind Canada) in overall healthcare system performance.[xiv]
The bottom line is that there is not a shred of evidence that industrialized countries with a single-payer system delivery an inferior quality of care compared to the US.
In addition to being poorly ranked in outcomes, we also rank poorly in preventative care. A survey comparing preventative care access, Americans were almost five times more likely to skip out on preventative care testing recommended by their doctor due to lack of access and/or insurance coverage.[xv]
4 – “I work hard, that’s why I have good healthcare coverage”
There are 46 million uninsured Americans. There are another 25 million that are “under-insured.” Allow me to show the breakdown of those 46 million that are uninsured.
-One-third of the 46 million are children.
-93% reside in households with an income of greater than $50,000 per year.
-64% reside in households with an income of greater than $75,000.
-1.8 million are veterans.[xvi]
Healthcare costs have risen 78% since 2001 while wages have risen only 19%.[xvii] The bottom line is that the average working family simply cannot keep up with the costs associated with keeping their family insured.
5 – “The government can’t afford to provide healthcare to everyone”
NEWS FLASH: THE GOVERNMENT ALREADY PAYS FOR THE MAJORITY OF HEALTHCARE COSTS!
The government already funds 57% of healthcare in the US![xviii] This includes government employees, military, Medicaid, Medicare, etc. Additionally, a little known secret is that your tax dollars actually fund my post-doctoral training. The hospitals receive approximately $100,000 per “residency” position in exchange for guaranteeing that they will accept patients with Medicare. This was originally started when Medicare was signed into action, fearing that hospitals would not accept coverage. In exchange for providing care for Medicare patients, hospitals would receive a sum of money to train “resident” physicians. There are many ways in which the government is currently funding healthcare that the average tax-payer is unaware of. If it weren’t for the Medicare payouts for resident training many inner-city hospitals would not be able to afford to keep their doors open.
Additionally, government-run healthcare costs less, plain and simple. Medicare spends less than 3% on administrative costs. That is in comparison to private insurance companies that spend 10-31% of total costs on administration.[xix] It is simply lean and more efficient.
6 – “Universal healthcare would cause an exodus of healthcare providers”
This chart shows the movement of Canadian physicians abroad versus those returning to Canada. As you can see in the past three years there have been more physicians coming home from abroad in comparison to those leaving.
There is no evidence to support the claim that it would cause a “brain drain”. More and more Canadian physicians prefer the single-payer system, hence the net return of physicians.[xx]
7 – With free healthcare, the system would result in over-consumption
A study published by Johns Hopkins University in 2007 compared ED use in America to that of Ontario, Canada with controls for demographical variation. They found, “ED visit rates and patterns are similar in the United States and Ontario, Canada.” The US had a total of 39.9 visits per 100 people in comparison to Canada having 39.7 visits per 100 people.[xxi]
8 – “Canadians are always crossing the border for healthcare”
In a 2002 survey of hospitals in border cities, they found:
-Greater than 80% of the hospitals reported seeing less than one patient per month.
-During the entire year, state hospitals in NY, MI and WA reported treated a total of 909 Canadian patients, only 17% of which were elective.
-Only one of “America’s Best Hospitals” reported seeing more than 60 Canadians over the previous year.
-In the survey of 18,000 Canadians, only 90 reported receiving care in a US facility. Only 20 of them came to the US seeking care.[xxii]
This claim is simply a myth with no evidence to back it up.
9 – “American doctors and nurses don’t want to become government employees”
A 2007 poll demonstrated that the majority of physicians and healthcare providers are in favor of universal healthcare. Just over 59% of physicians polled support a government organized healthcare plan. In Massachusetts, 64% prefer the single-payer system over private healthcare options. Moreover, 64% of all physicians polled are in favor of a universal healthcare program even if it resulted in a 10% pay cut so long as it reduced the amount of paperwork.[xxiii]
Additionally, single-payer medicine is not socialized medicine. In a socialized medicine system the doctors are government employees and the hospitals are property of the government. With a single-payer system, doctors and hospitals remain private. The billing is simply funneled through a single-paying source instead of having to hire billing specialists just to bill the 1500 different insurers that currently exist.
10 – “Canadians have to purchase extra coverage just to be seen by the ‘good’ doctors”
More than 99% of physician services are covered by Canada’s single-payer system. Just over 90% of total hospital costs are paid for by the government. Most of the extra coverage that is purchased is for dental care, which is currently limited in coverage. That amounts to a total of 70% of total healthcare costs being paid for by the government health plan. Most of the remaining 30% is due to dental care which is not generally covered by their universal healthcare plan. Additionally, the vast majority of physicians are private healthcare providers.[xxiv]
The bottom line is that we cannot afford to ignore this problem anymore. A tax-credit or step-wise process simply will not work. It has not worked anywhere else, and will not work here. Those that have insurance are paying for those that don’t. There’s a reason why a CT scan in the ER costs you over $1000, they have to make up for all of the care that is provided to people that cannot pay. Additionally, having universal healthcare places everyone in a common risk pool. It prevents the ability for insurance companies to cherry-pick the best patients. Try getting health care coverage with a history of breast cancer, heart disease or any chronic illness for reasonable rates.
Americans don’t want a choice of health insurance policies; rather, they want a choice of doctors and hospitals.
Special thanks to Dr. Jim Mitchiner at St. Joe’s Medical Center for allowing me to use some of his work in writing this.
[i] Income, Poverty, and Health Insurance Coverage in the United States: 2007, US Census Bureau, http://www.census.gov/prod/2008pubs/p60-235.pdf, Accessed: 14 July 2009.
[ii] Medical bills leading cause of bankruptcy, Harvard study finds, http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html, Accessed: 15 July 2009.
[iii] J Gen Int Med Suppl, April 2004, 19:147
[iv] Health Affairs, July/August 2004:228
[v] OECD Health Project, http://www.oecdwash.org/PDFILES/health2003_wash.pdf, Accessed: 10 July 2009
[vi] Self-Reported Difficulty Accessing Services, http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2006-fed-comp-indicat/2006-fed-comp-indicat-3-eng.php#a1, Accessed: 17 July 2009.
[vii] Note to Medicaid Patients: The Doctor Won’t See You, http://online.wsj.com/article/SB118480165648770935.html?mod=todays_us_page_one, Accessed: 17 July 2009.
[viii] “The Doctor Will See You – In Three Months,” http://www.businessweek.com/magazine/content/07_28/b4042072.htm, Accessed: 18 July 2009.
[ix] Opportunity ‘08, “Meeting the Dilemma of Healthcare Access,” Accessed: 10 July 2009.
[x] OECD Health Data 2009, http://www.oecd.org/dataoecd/46/33/38979719.pdf, Accessed: 10 July 2009.
[xi] Davis et al. “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care”, http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror–Mirror-on-the-Wall–An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx, Accessed: 17 July 2009.
[xii] CIA – The World Fact Book: Infant Mortality Rate, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html, Accessed: 17 July 2009.
[xiii] CIA – The World Fact Book: Life Expectancy at Birth, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html, Accessed: 17 July 2009.
[xiv] The World Health Report, http://www.who.int/whr/2000/en/annex01_en.pdf, Accessed: 17 July 2009.
[xv] Schoen et al. Health Affairs.2007; 26: w717-w734
[xvi] Schoen et al. “How many are underinsured? Trends among adults.” Health Affairs, 10 June 2008.
[xvii] “Health Insurance Premiums…” The Kaiser Family Foundation, http://www.kff.org/insurance/ehbs091107nr.cfm, Accessed : 18 July 2009.
[xviii] OECD Data, 2005.
[xix] “Statement of Dr. Marcia Angell Introducing the National Healthcare Plan,” http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php, Accessed: 18 July 2009.
[xx] Canadian Institute for Health Information statistics, 2006
[xxi] Li et al. “Emergency department utilization in the United States and Ontario, Canada.” Acad Emerg Med. 2007 Jun;14(6):582-4. Epub 2007 Apr 30.
[xxii] “Survey of US Ambulatory Care Providers in Border Cities…” Health Affairs, 2002, 21:19.
[xxiii] Gallup Poll, 10/9/2007
[xxiv] CIHI – Exploring the 70/30 Split, http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_1282_E, Accessed: 17 July 2009.
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