National Health Insurance,
and More Cost Effective Care Providing System
the testimony of Dr Jonathan Weisbuch - HR676 The right plan for health care in
See a summary of HR
676 - the Single Payer bill in the U.S. House of Representatives
Our current health care system is the most
costly and least effective of all industrialized nations:
A large part of the money (31%) goes to the insurance companies. These include the
salaries of the legions of administrators and attorneys charged with
approving/denying claims, advertising, client signup bonuses, etc. Insurance company profits and the pay of
their executives are outrageous. In contrast, Medicare administrative costs are
Drug costs are substantially
higher than in other countries.
Physician pay (particularly
for specialists) is high. Part of that is justified by the
outrageous cost of malpractice insurance. The cost of physician
education is another salary justification.
Hospital care is too costly.
Hospitals compete rather than work together to develop efficient "best
practices". There is little incentive for reducing costs; they simply
charge and get higher prices. Despite their protests, most hospitals
are flush with money. They build elaborate new facilities, often
reducing the number of beds available. They donate sports facilities
to our high schools. We pay for all of that in our high health care
Unnecessary tests are run as
directed by the hospital legal staff to avoid potential law suits.
There are shortages of
physicians and other medical practitioners. Many have left the
profession due to high malpractice insurance.
See my discussion of the shortage of
More than 47 million Americans have
no health insurance. They still get emergency care as a hidden cost to
the hospitals. When they finally go to a hospital, their conditions are
often more serious and more difficult and costly to treat.
A current related issue is the common practice of hospitals and attending
physicians charging uninsured patients three or more times the rate they charge an
insurance company for the same treatment. This should be outlawed.
While the Affordable Care Act
is a good step forward, a single payer national health
system is the answer:
A single public agency makes
health care insurance available to all while the delivery of care remains
costs under a single payer system will be on the order of the 3% with Medicare. The system will
avoid the high insurance salaries and profits, and the administrative costs
centered on claims denial and legal defense of unsavory practices.
Drug costs can be negotiated on
a large scale basis. (In this we must be cognizant of the legitimate
costs of the drug companies.)
The justifications for
exorbitant physician pay can be reduced. Malpractice insurance can be
very substantially reduced. See my discussion of civil suit
control. As is currently done by the Armed Forces, physician (as well
as nurse, nurse practitioner, and physician assistant) education can be
subsidized in exchange for years of service at reasonable pay.
Control of litigation will
also restrain the conduct of unnecessary medical tests which are required by
hospital and HMO attorneys to avoid law suits.
For several years at the start
of this century, the Veteran Affairs hospitals provided superior care
at a much lower cost than civilian hospitals. Bush administration cost
cutting has hurt the VA since, but the methods the VA demonstrated still
show what can be done. Under a new administration the VA will be able
to recover. The VA methods can be shared along with other "best
practices" with all hospitals. The cost reductions achieved by the VA
can be used for guidelines for reimbursement.
development is needed along with electronic medical records. The state of
the art in this area must be codified so that all medical facilities can
implement this technology. It is estimated that this technology will
save the economy $77 Billion annually. Electronic records using
a standard format can be used for statistical research to find the most
successful and the most cost effective treatments for patient conditions.
Another needed improvement is a
graphically enhanced phrase catching system for physician (and technologist)
notes. Such a system would save a substantial amount of medical
personnel time and improve the clarity and accuracy of medical records.
With universal health care,
everyone will be covered. Preventive health care will be available to
everyone and costs to the system will be lower. This is another
case where doing the morally right thing is doing the cost effective thing.
Like all financial matters, this
is a zero sum situation. To reduce the cost of health care for the
nation, we must reduce the amount of money being stolen by insurance CEOs,
overpaid physicians, drug companies, and others. We should strive for
the American dream of decent health care for all. We should not strive
to satisfy the unbridled greed of a relative few.
I envision a system in which people
will pay premiums to the system as they do now (but lower) with co pays for
drugs and visits. The system must be set up to prevent abuse by both
patients and providers. Computer analysis will be used to detect patterns
Universal health care is a moral
imperative. But, it will also improve the economy. The current
excessive cost of health care, though not part of the Federal budget, is still a
drag on the economy. With a lower total cost of health care, money will be
freed for other essential services. With the burden of employee health
care removed, American businesses will be more competitive with foreign
companies which currently do not have to absorb those costs.
See the Single Payer Top Ten list from Physicians for a National Health Program.
to Physicians for a National Health Program web site.