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In recent months there has been many fears expressed about a government take over of our health care system. This often repeated fear seems to not understand that the U.S. government has not already taken over much of the U.S. health care system. The fear also implies that a government take over would be bad for our healthcare quality, and would be bad for our economy. The conclusion from this group is that we need to run away from government health care. The rest of the world does not see it that way. In fact the U.S. is the only developed country in the world that does not have a national health care program that provides health care for all its citizens. The Universal Declaration of Human Rights, adopted by the United Nations in 1948, proclaimed that “everyone has the right to a standard of living adequate for the health and well-being of oneself and oneʼs family, including food, clothing, housing, and medical care.” The United States though instrumental in passing this declaration does not live up to the human rights declaration in this regard. Martin Luther King Jr. said it this way: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Despite the fact that millions of Americans have no health care coverage, the U.S. is third in per capita spending for public health care with only Iceland and Germany spending more per capita. In fact The U.S. system is so lacking that others are wondering not why people want to run away from public health care but rather why they donʼt want to run to it like the rest of the world has already done. See public per capita health care spending by country:
Existing Government Health Care Programs While some call health care reform a government take over, the truth is that without the existing government health care programs the broken U.S. health care system would be in much worse shape and millions more would lack health care. The VA Medical Center alone is the second largest employer in the Federal government with only the Defense Department employing more people. Imagine if Veterans did not have this health care program. Add to this the health care costs related to Medicare, Medicaid, TRICARE, Social Security disability payments, the Childrenʼs Health Insurance Program (CHIPS), health insurance for federal employees, and members of Congress and you get an idea of the extent that the federal government has already taken over much of the health care in the nation. Add to this the health care provided by state and local governments and the government control of health care is even stronger. The U.S. spends more per capita on the public portion of its health care than France spends on its entire health care program. France covers all of its citizens and is ranked the number #1 health care system in the world by the World Health Organization. The U.S. by contrast is ranked only #37. See: http://www.photius.com/rankings/healthranks.html Let that fact sink in for a minute. The cost of just the government portion of health care in the U.S. before the recently passed health care reform legislation, exceeds the per capita cost of France which covers every citizen and is rated #1 health care system in the world. Government health care is not new in the U.S., it is a primary component of the total U.S. health care system with about 46% of health care expenditures paid by the government. Imagine what would happen if we were to run away from this 46% health care expenditure to “gain more freedom”.
Quality of Government Health Care Programs With the notable exception of the VA Medical Centers, the government does not actually run health care programs but rather primarily reimburses people in the private sector at the rates the private sector can demand. In other words people using medicare, medicaid, CHIPS, etc. are using the same private health care system as anyone else in the private sector. They are just paying for it with government funds rather than private insurance.
The VA Medical System that does provide government health care, delivers its health care programs primarily to U.S. Veterans though a few other groups also qualify for its programs. This is somewhat of an irony because on the one hand there are people who are screaming that if the government runs their health care they will be losing their freedom and on the other hand this same group seems to have no problem that the veterans who fought for their freedom are using government run health care. Many Veterans though are not running away from their government health care opportunity at all. In fact they gratefully run to it with its high quality of care. While there was a time when the VA Medical system was considered inferior by many, there has been a dramatic change in the last decade of the VA Medial Center quality of care. Much of this is detailed in an article by Phillip Longman titled “Best Care Anywhere” where he reports the following re: the VA Medical system. • The New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be "signiﬁcantly better. • The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care. • The National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals. • In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients. Full article at http://www.washingtonmonthly.com/features/2005/0501.longman.html
Other signiﬁcant ﬁndings re: the VA include: • A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality; Patients from the VHA scored signiﬁcantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care. • A 2009 Congressional Budget Ofﬁce report on the VHA found that "the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines In summary the VA government run health care out performs the private sector in terms of quality care.
Economic Impacts of Government Health Care Programs. On March 1, 2010, billionaire Warren Buffett (who is considered one of the worldʼs most savvy investors) said that the high costs paid by U.S. companies for their employeesʼ health care put them at a competitive disadvantage. He compared the roughly 17% of GDP spent by the U.S. on health care with the 9% of GDP spent by much of the rest of the world, noted that the U.S. has fewer doctors and nurses per person, and said, “that kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body” Could running toward a stronger public health care system be the answer? Experts respond with a resounding yes! One of the biggest potential savings in a public health care system is the savings in administrative costs. The administrative cost of health care in the United States health care system is about 7.2 percent of the total health care costs. This breaks down as follows: Private health care " " Medicaid " " " Medicare" " " " " " " " " " " " - 14.2% - 7.0% - 3.1%
A national health care program could save $250 billion a year in the nationʼs $2.26 Trillion health care bill in administrative costs alone by implementing a medicare for all type program.
In a medicare for all type program, doctors, hospitals, and other health care facilities could still operate independently. The difference would be that they would be reimbursed through medicare rather than private insurance. The government would not need to take over the health care system, they would simply take over the administrative reimbursement for the system. With the unnecessary middle man role that the insurance companies now play gone, the savings would be enormous. There would be additional savings with a large system better able to negotiate prices on drugs, medical supplies, and other services. Total cost savings a year are estimated to exceed a minimum of $400 billion. Some estimate much higher. If the American people had an additional $400 billion to pump into the economy each year that would be a huge stimulus for the economy. There are also lessons to learn from the VA Medical system that operates at about 20% less budget than private health care systems. In the private hospital system, money is made from people who are sick. In the VA system they have their patients for life so they also have incentive to keep them well. Part of the turn around for the VA was a series of new innovations that included: • putting all the patients records on a laptop so doctors did not to redo tests, a costly expense many private hospitals make because they donʼt have access to the patients records. • using a barcode that can be scanned on a patients wrist band as well as the medication they are taking. If they donʼt match the patient doesnʼt get the wrong drugs. About 1.5 million patients are harmed each year by med errors, a problem that is virtually not existent in the VA. • During the Clinton years the VA eliminated about 52,000 hospital beds and instead invested in about 300 community clinics that emphasized prevention. An article in Time Magazine points out that one way to cut the cost of health care in the U.S. would be to allow Veterans on Medicare to use that money for VA treatment. Medicare spends an average for $6500 per patient reimbursing the private health care system while the VA spends only $5000 per patient. Cutting costs by more than 20% would be a big contribution. If one were to add to the VA innovations programs to improve wellness including nutrition, physical ﬁtness, stress management, development of reasoning and critical thinking skills, and wise use of medical resources, even more savings could be obtained. To read the entire Time article on how the VA became the best healthcare see: http://www.time.com/time/magazine/article/0,9171,1376238-1,00.html
The cost of running away from public health care instead of running toward public health care is unsustainable In a presentation by Dr. Leonard Rodberg on the economics of health care, he notes that because of medical bills for americans in the last ﬁve years: • • • • • • 20% have been contacted by a collection agency. 20% had difﬁculty paying other bills 17% used up most all of their savings 12%have been unable to pay for basic necessities 10% borrowed money or took out a 2nd mortgage 3% declared bankruptcy
The presentation goes on to point out that according to the Congressional Budget Ofﬁce, the health care reform legislation just passed will not cut costs signiﬁcantly and not limit the continuing rise in costs. The one trillion dollar health care reform bill is still not enough to insure all Americans. On the other hand a Medicare for all approach would cost less than $300 billon, cover all Americans, and control costs. If left unchecked, by the year 2025 the American Family Physician predicts that the average health care premium will be equal to the average household income in the U.S. See full powerpoint presentation at: http://www.authorstream.com/Presentation/ pnhpnymetro-272402-health-care-obama-ﬁrst-year-pnhp-national-insurance-singlepayer-medicare-reform-conyers-hr-676-11-14-09-education-ppt-powerpoint/ Conclusion: The fear of a government takeover of health care is unfounded, ignores the fact that the government already has signiﬁcant control of the nations health care system and that a better administrative system would not take over any health care facilities or practices. A public health care system would have reason to focus more on prevention and wellness, have greater purchasing power as a large system, be better ability to coordinate patient care through nationwide computer systems, and have far less administrative costs when it comes to billing. Unlike private health care organizations, a public health care system would not need to make a proﬁt on others misfortunes. Cutting out the insurance companies as an unnecessary middle man and going to a “Medicare for All” type system could both reduce health care costs and control future health care costs in a way private health care will never be able to do.
The ﬁght to remove the cancerous insurance industry from health care in the United States will not be easy but it will be necessary if the economy is to have a ﬁghting chance for sustained recovery. It is time to stop running away from public health care and start running toward it.
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