|
What Can We Do About Our Failed Health Care System?
By Tom Sevigny, Canton
Tom Sevigny is Green Party candidate for State Senate in the 8th District, which includes the communities of Avon, Barkhamsted, Canton, Colebrook, East Granby, Granby, Hartland, Harwinton, New Hartford, Norfolk, Plymouth, Simsbury and Winchester.
Last Sunday I was talking to some friends and the conversation turned to health insurance. We soon discovered that despite the fact that we all have health insurance through our employer, we are paying more and more for our health insurance coverage and receiving less and less. Higher deductibles and less coverage seemed to be our collective experience. Ironically, I happened to have health care conversations with two other people the very next day who are self-employed. They are both paying over $800 a month for health insurance for their family, and one of them will see their premium increase to $1,300 a month next year simply because he is turning sixty.
I have a feeling that my anecdotal conversations this past week are pretty much indicative of the state of our current health care system. My conversations, of course, did not even broach the other problems with our health care system: the uninsured, high cost of prescription drugs, the under-insured, etc., etc. For the past decade or so, politicians from the two major parties have been tinkering with our health care system with little success. The same problems continue to plague the system and no solution seems possible.
I will argue below that the public financing of comprehensive health care insurance for all Connecticut residents would be more effective and more efficient than our current health care system and would correct all of the problems associated with it. First, let’s define what our current health care system is and the problems associated with it.
Our current health care system is an uncoordinated system of public insurance for the elderly and disabled through Medicare, public insurance for the poor through Medicaid (Husky), public insurance for low-income children (CHIPS), employer-based insurance, private insurance for the self-employed, and non-insurance. The problems associated with this hodgepodge system are numerous.
The first is cost. The cost for employers and private insurance continues to increase dramatically. As a matter of fact, costs in the United States have risen faster than in any other industrialized nation since 1990, and insurance premiums are expected to increase 20% or more this year on top of double-digit increases last year. Such high costs create an increasing amount of people who have no health insurance. In December of 2000, 279,210 people in Connecticut were uninsured—or about 8.5% of our residents. This number has increased by 12% since 1990. The uninsured are sicker when they seek treatment and are more difficult and expensive to treat. In 1996, there were approximately 18,000 hospitalizations in Connecticut costing $107 million that could have been avoided with the outpatient care associated with insurance coverage.
Because health care insurance is so expensive, companies, individuals and governments seek to get around this expense by providing limited, non-comprehensive, and hence inadequate insurance. This is our second problem. The most often mentioned problem with inadequate insurance is the cost of co-pays, most commonly discussed in terms of the high cost of prescription drugs. This is particularly apparent in the Medicare program, where senior citizens are spending on average 25% of their disposable income on health care.
However, there are two other problems associated with inadequate health care coverage. First, 25% of Connecticut residents would be bankrupted by a major medical illness due to under-insurance; generally speaking, medical bills are the number one cause of bankruptcy in our state. Second, inadequate health coverage creates access and quality of care issues. About 81% of physicians say that needed heath care is denied by managed care companies. And, most importantly, for-profit outpatient care, inpatient care and for-profit nursing home care has been consistently shown to be inferior on all 16 federal quality of care indicators.
Why is the U.S. health care system so expensive? The major cause is administrative costs, which account for 15-25% of expenses. Administrative costs in other countries are 8% or less, but this includes preventive health care education. The highest administrative costs are associated with the for-profit health insurance companies because they manage each case. Other reasons that our system is so expensive include the large number of uninsured, lack of preventive health care, and the cost of prescription drugs.
How does this expensive, uncoordinated and inefficient system rank us with the rest of the world? Well, despite spending the most per capita of any country, having the best trained doctors and the best medical infrastructure, the United States ranks 23rd in infant mortality, 25th in life expectancy, and near the bottom in preventative health measures such as immunizations. We are also the only industrialized nation that does not guarantee health insurance as a right of citizenship.
So what is the answer? The answer is a universal, comprehensive health care system for all of Connecticut’s residents. Such a universal system would decrease administrative costs, lower medication costs, coordinate the health care system and emphasize preventative health care.
How would this work? We should establish a Connecticut Health Care Trust that would pay for comprehensive health care, including medications and long-term nursing care, for all Connecticut residents. The system would actually save money, according to studies conducted by the State of Connecticut and all other studies on this type of health care system done by other states and the federal government.
It is important to note that the Connecticut Health Care Trust would be a publicly controlled, non-government system that would run under a board composed of government officials, health care professionals, health care organizations, advocates for health care, representatives of payers, and health care professionals. By having the board composed of these various representatives, the decision-making process would be democratic with all groups fairly represented. In addition, patient and professional advisory councils would be established to assist and watchdog the day-to-day administration of the trust. In this way, the trust would be a program of the people, by the people and for the people.
The system would save money by limiting the administrative cost of payments to 3%, by purchasing medications and durable medical equipment in bulk, and by coordinating the health care delivery system. The State of Connecticut, Office of Health Care Access predicts overall savings of $1 billion to $2 billion a year if this system were enacted in the state. Health care professionals would be paid fee for service with rates determined in negotiation between health care professionals and the Trust. Health care organizations, such as hospitals, would be paid on a global budget basis, freeing them of the burden of billing for each procedure and piece of medical equipment used.
Funds to pay for the operation of the Trust would be generated from a surtax on activities detrimental to health (such as smoking), an individual health care tax, and a pooling of all public funds being used to pay for all individuals with public insurance programs in the state of Connecticut. It is anticipated that major corporations and the average individual would pay less under this system than what they are currently paying for health care. It is further anticipated that 80% of individuals would pay less, while individuals with the highest 20% of income would pay more, but the same percentage as everyone else.
It is time we stop tinkering with our broken health care system. Such tinkering is like rearranging the deck chairs on the Titanic—it may look a little nicer but the ship is still sinking. A Connecticut Health Care Trust, on the other hand, would mean no medical bankruptcy, and free choice of any licensed health care provider. All people would have access to the same high-quality, comprehensive health care regardless of their socio-economic status. The denials of needed care caused by managed care would cease. The loss of job caused by medical illness under managed care would cease. The costs of adjudicating medical expenses under workman’s compensation would cease, causing a decrease in the costs of workman’s compensation for employers. Employers’ health care costs would on average decrease, and the uncertainty of health care costs for employers would cease. The necessity of bankruptcy or distribution of assets to children to qualify to get into nursing homes under Title 19 would cease. And most of all, the anxiety that health care costs represent to individuals and families in Connecticut would cease.
If you would like to find out more about a publicly funded, comprehensive health care system for Connecticut or learn more about my campaign, please call me at 860-693-8344. You can check out my website at <www.ctgreens.org>.
|
|
