Dear Dr. __________:
With regard to our conversation in the doctor’s dining room today, I’d like to make the following comments.
The portion of GM’s $1500 per vehicle cost for health care (Modern Healthcare 35:14, 2005) that is attributable to current workers versus retirees is irrelevant if you believe, as I do, that universal health care is one of the elements of true health care reform. I don’t care if it’s a current GM worker or a GM retiree receiving a health care benefit; frankly, I want them both to have good health care. I care about the vast waste and greed in the U.S. system for financing health care that is the proximate cause of the large health care price tag on GM cars. The high cost per vehicle is not because blue collar workers are getting an unearned or undeserved benefit. Japan provides universal health care — including both current Toyota workers and Toyota retirees — and Toyota’s health care cost per vehicle is $97. A wide range of U.S. businesses suffer in competitiveness compared to those in countries with cost-effective health care systems.
I believe that a truly reformed health care system must be universal, equitable, comprehensive, affordable, preventative, accountable (have effective public oversight) and evidence-based. All other industrialized countries have some form of universal health care and spend far less — about half as much per capita — than the profoundly dysfunctional U.S. system. Americans already pay for universal health care, but don’t get it — taxpayers already pay for 60% of all health care costs in the U.S., and this amount is more than total costs in other industrialized countries, except Switzerland (on a per capita basis; Health Affairs 21:88, 2002). The U.S. ranks poorly in terms of outcomes: out of 19 industrialized countries, the United States ranks last in reducing deaths from treatable conditions (Measuring the Health of Nations. Health Affairs 27:58, 2008).
I’m puzzled about your response to my factual description of the administrative waste and inefficiency in the financing side of U.S. health care. I don’t believe that corporate greed in this area must be tolerated. We need not tolerate predatory and parasitic for-profit insurance companies siphoning off more than $350 billion per year. This money provides no health care and is a drain that drives health care costs through the roof and prevents millions from getting needed health care. 59% of U.S. physicians support single-payer national health insurance for financing health care (Annals Internal Medicine, 2008). Poll after poll shows that at least 62% of the U.S. public supports single-payer national health insurance. The public is enthusiastic about publicly funded, privately delivered, expanded and improved Medicare for all — they understand that this reform will enhance real choice (choice of doctor and hospital, not choice of insurance company) and protect them from medical bankruptcy.
As you were leaving, you quoted the Declaration of Independence (“…Life, Liberty and the pursuit of Happiness”), making the point that Thomas Jefferson didn’t specify health care as one of the unalienable rights. Nor did Thomas Jefferson say anything about police and fire protection in the Declaration of Independence. Both police and fire departments are accepted as vital public services (which, of course, are public on both the financing and delivery sides). When your house is on fire, the fireman does not ask for your insurance information or ask if you’ve paid your service subscription. Certain services, including police protection, fire protection and health care insurance are clearly integral to “life, liberty and the pursuit of happiness” and are appropriately in the public domain. The market is appropriate for auto insurance and microwave ovens, but it has been a miserable failure in a vital, non-discretionary area such as health care insurance. About 18,000 American adults die unnecessarily every year due to lack of insurance (Institute of Medicine study in 2002; the number is currently about 22,000 per year). The corporate health insurance industry bears proximate responsibility for these deaths, hundreds of thousands over the years that the foxes have been in the henhouse. Incidentally, Thomas Jefferson apparently borrowed the phrase from the English writer John Locke, who said “no one ought to harm another in his life, health, liberty, or possessions.” Jefferson considered Locke to be one of “the three greatest men that have ever lived”. John Locke clearly recognized the central importance of health. In any case, it is clear that Jefferson was not being exclusive in his list of unalienable rights: “…certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” (emphasis added).
My response to your citation of Thomas Jefferson and the Declaration of Independence was to say, “health care is either a commodity that is based on ability to pay or it is based on need”. I would like to add: Doctors and hospitals are increasingly fed up with the current system. Increasingly, both realize that treating health care as a commodity that some can afford and others cannot — apportioned based on profit motive and the ability to pay, rather than need — is the most irrational and inhumane form of rationing and interferes with their mission of providing high-quality, compassionate, evidence-based, necessary health care to patients, while still maintaining adequate operating budgets, capital budgets and incomes for health care providers and administrators.
This is not “pie in the sky” utopian ideation. We’ve had a giant experiment in the U.S. since the end of World War II, with the rest of the industrial world acting as a control. The data and evidence are clear: to a scientific certainty, only a single-payer system of health care financing will solve the serious problems and achieve high-quality, comprehensive and affordable health care for all Americans. The cherry picking of the risk pool by “insurance” companies and their denial of claims in order to maximize profits profoundly harms millions of Americans. We should follow the example of John Snow, M.D. (1813-1858), who took the pump-handle off the Broad Street pump in order to stop a cholera epidemic — let’s take the handle off the Health Insurance Misery and Death Pump, ban the parasitic middlemen and stop this epidemic.
Daniel P. Wirt, M.D.