As the Star Tribune expressed so dramatically in a series of articles last Sunday, our health care system is in a state of crisis.
It’s time for Washington to listen to the voices of the people without adequate health insurance – children, workers, farmers, those in small businesses, the unemployed, the senior citizens.
Families are forced to scratch for new health care providers every year because their employers continually change insurance plans in a futile attempt to hold down medical costs.
Businesses face spiraling costs for insurance for their employees, a 46 percent increase in the last two years alone. Families are bankrupted by long-term illness, a fate that could befall almost any one of us.
We are past the point of debating whether there is a crisis. There is a crisis, and it demands a national solution. Individuals alone, businesses alone, health providers alone cannot solve the problem by themselves.
Even states alone cannot solve the problem – including Minnesota which has an unparalleled health care industry and health care legislation.
We must work together as a nation to create a system where affordable health care is a right of citizenship.
We are the only major industrialized country other than South Africa that fails to guarantee all citizens access to medical care. Yet public opinion polls show solid support for the principle that health care should be a right.
The key to any solution is to control health care costs. Unless we control costs, we simply will not be able to pay for a fair and just health care system.
We spend more per person on health care than any other nation, more than 12 percent of our gross national product. We must spend our health dollars more efficiently and more wisely.
A large part of the expense is the astronomical sum of money spent on health care bureaucracy and administration. We spend nearly a quarter of our health dollar on billing and administration and redundant paperwork, instead of on the actual care of people in need.
And the bureaucracy continues to grow. In fact, the number of health care administrators is rising three times as fast as the number of physicians or other health workers.
We must curtail this unnecessary growth, streamline administration and devote more of our health care dollars to the treatment of people.
The best way to do this is through the national health insurance program – funded through a single source, the federal government, but administered locally. Services would be delivered through the same sources as today: private doctors and nurses, health maintenance organizations, hospitals, clinics, nursing homes. In other words, the federal government would finance the system but would not run the hospitals, the clinics, the doctors’ offices.
Services would be delivered through a pluralistic framework offering a variety of options to patients. Consumers of medical care would be encouraged to become more involved in shaping the delivery of services in their regions. Emphasis would be placed on primary and preventive care through accessible community facilities in order to address health problems before they become more serious – and more expensive.
The goal would be to make the system simpler. Patients would not be billed for needed medical services. Administrative costs would drop dramatically with a single payer, the federal government.
Capital costs for health care would be budgeted on a regional or statewide basis. This would allow for a rational and controlled system of decision-making instead of the current system, accurately described by the Star Tribune as a “medical arms-race.”
Such a system can work – and does, in Canada. We need to study the Canadian example, learn from its successes and failures, and use American innovation and technology to establish the finest, most efficient and most equitable health system.
In large measure, the cost of a national health insurance program could be borne by the savings gained from administrative efficiencies and other cost control measures. These savings may even pay part of the expense of the long-term care program.
The idea of a national health insurance program is getting increased support. Two years ago, several hundred physicians endorsed a proposed national health insurance program in an article in the New England Journal of Medicine. Today, several physicians’ organizations, representing thousands of doctors, support the concept. Legislation has been introduced in Congress.
Along the way, there may be interim measures to ease the pressure on our current health care system, including the proposed Minnesota health care access bill. But we must not fail to address the basic underpinnings of the crisis.
Too many people have no health insurance. Too many people have too little insurance. Too many families have to mortgage their futures to pay bills when catastrophic illness strikes a loved one. Too many businesses cannot afford to pay premiums of their workers. All this is in the country with the best medical services and research in the world.
It’s time for a fundamental change to address a fundamental problem.
– Paul Wellstone
(Reprinted with permission from the Star Tribune 3/31/91.)