Why is it that the United States, which is held out to be the greatest country in the world to live in by many and using many different standards, is the only Western country that does not have some form of socialized medicine? One reason is that opponents continue to refer to any universal health care program as just that, socialized medicine. The label alone is enough to prevent many people from supporting such an effort, without looking any deeper to the facts of the situation or the solutions it offers. The connotation behind the expression socialized medicine is that it is a system that belongs in a communist run country. Socialized medicine refers to a health care delivery system where the hospitals are owned by the government and the doctors and other caregivers, whether in a hospital, office or other setting, are all government employees. And while I agree that this is not the system that would be effective for this country and our problems, we do need a system of universal health care for many reasons.
Universal health care refers to a health care delivery system where there is a single payer for services, and that payer is the government. Of course, this requires administration on a local and national level by government agencies and their employees, but the hospitals, physicians and their offices and other health caregivers remain privately owned. This is the system that this country desperately needs. And while it is certainly not a perfect system, as we will examine later, it is far and away much better than the system we now have. Our current system is flawed beyond repair. Over 40 million Americans do not have any form of health care insurance or coverage of any kind. This costs the country in many different ways. First, it is a huge economic drain, as those without coverage do not seek health care on a regular basis, even when it is needed. Ultimately, these people end up in the emergency rooms of county run hospitals, with costs many times more than the care they initially needed, and those costs end up being born by the government and its taxpayers.
Equal access to health care would seem to be a basic human right yet in this country it remains a privilege, available only to those who can afford it. Many opponents argue that despite the flaws in our system that we still have the best health care in the world. But the key question is: By which standards? “Of the top twenty four industrialized (modern) nations, the U.S. ranks twenty-first in infant mortality and sixteenth in life expectancy. Yet we spend more than 40 percent more per capita on health care than any other nation.” (Cavanaugh 1999). If the numbers are so clear and the possible solution so obvious, than why are we still stuck with our current system? One reason is the money, and political power that goes with it, of major corporations such as the pharmaceutical industry. Under a single payer system, pharmaceutical companies have to bid on a regular basis for the contracts to sell to the hospitals.
This competitive bidding keeps the price of prescription drugs down. They also have to negotiate with the government agency regarding the price of prescriptions sold in retail pharmacies, again keeping the price way down. Needless to say the pharmaceutical companies would rather deal individually with hospitals and pharmacies or retail chains than one payer who is the only game in town. This centralization is one of the many reasons health care costs, especially those for prescription drugs, are lower in a single payer system. In a recent example, Medicaid was being charged $76 for a prescription medication and reimbursing $60 to the providers thereof on a regular and ongoing basis. However, it was discovered that doctors and hospitals were paying $4 for the same drug not a generic from the same manufacturer.
Our system is also running rampant with fraud and the cost to the system in losses due to fraud and efforts to contain and eliminate it. But these efforts are mostly after the fact, and are essentially attempts to recover money that has been paid out incorrectly. The United States Attorney for the Southern District of Florida spends over $3 Million a year in fraud prosecution. (Acosta 2008). In 2006 state and federal spending on Medicare and Medicaid programs totaled over $300 Billion. Medicare introduced a pilot program in 3 states Florida, New York and California called RAC (recovery audit contractors) where agencies hire private companies to recover wrongful payments and are paid a percentage of what they recover.
In 2007, over $300 million was recovered in fraud cases, over $135 million of that in the State of New York alone. (Sheehan 2008) These RACs were so successful that Medicare is expanding the program to additional states, and plans to eventually roll it out to all states. Currently, for example, there is no way to cancel a Medicare number and re-issue a new number to the beneficiary. So if fraud has occurred, you have to try and recover the funds, but cannot stop the continued or additional misuse in the future. Naturally, the fraudulent user can lose their rights to participate in the system, but identity thieves can simply bill under a different participating provider number and continue to use the same stolen Medicare number until they are caught and stopped again.
Economic savings in a single payer system would bring benefits to the self employed and small employers who struggle to provide decent health care coverage at an affordable rate. Large employers also stand to save huge amounts on their spending. And likewise the social security disability, welfare and workers’ compensation programs would save millions. Even other types of private insurers automobile, home, and casualty could save money and reduce fees by cutting costs on the health care portions of their coverage. The Medicare and Medicaid programs as we now know them would become obsolete. The time is right and the economic and social moral reasons have never been stronger, yet the resistance due to fear and misconception, together with deceit from those who stand to lose economically, continues to block the only logical choice for our health care system, a universal payer system with the government as the payer.
Acosta, Alex (2008). United States Attorney for the Southern District of Florida, lectureTo Health Care Compliance Association. Retrieved on May 4, 2008.
Cavanaugh, Gerald (1999). “Why doesn’t America Have Universal ComprehensiveHealth Care?” Retrieved on May 3, 2008.
Sheehan, James (2008). Medicaid Inspector General, State of New York, lecture toHealth Care Compliance Association. Retrieved on May 4, 2008.