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We're number 37

Fri, Feb 13th, 2009
Posted in Commentary

The Obama era was supposed to begin by dealing with four issues Iraq and the Middle East and all its permutations, the economy and the recession, healthcare systems, and lastly, all other entitlements.

The economy has sucked all the air out of the room so far. Iraq and Afghanistan have been ignored for the most part. The media believes Iraq is in good shape because of an election where they had to shut down the country and essentially declare martial law to get 50-percent of the vote out. Even closing the borders and allowing no motor traffic, several provinces were felt to be too unstable to allow them to vote, so they will vote later.

Great strides we are making in Iraq.

Six months ago meaningful healthcare reform finally seemed to be within reach. Consensus was building that the healthcare system was a train wreck that cost too much and delivered too little.

T. R. Reid produced a documentary for Frontline last April and is publishing a book next May. The title of the book, "We're Number 37!" This refers to the United States ranking by the World Health Organization. We do fairly well on outcomes, especially for cancers. For interventions that require ongoing care such as diabetes, hypertension, atherosclerotic diseases of the heart, brain and kidney-not so well. The reason we don't, is these require early and continuing care and is a measure of our access to care. It points out that we ration care now in the U.S. by the most cruel and venal way - the ability to pay.

Since I subscribe to many newspapers over the internet and receive blogs from both left and right leaning think tanks and pundits, I see a frightening thing arising. The discussion around healthcare is becoming too strident and sclerosed into extreme fixed positions. Both sides have extremists that are all ready monopolizing the discussion and defining terms of engagement.

Some of us remember the deceiving ad put out by the healthcare insurance companies featuring Harry and Louise. They were the couple concerned their healthcare would be run by Washington politicians; they would not be able to see their own doctor, or go to the hospital of their choice and there would be rationing of care.

Taking a page from that intellectual paragon "Joe the plumber" those on the right are redefining socialism as any government program that benefits individual citizens. Crying socialism also brings up images of communism, and to the population over 40 this is a great scare tactic. The old slippery slope argument.

They haven't convinced the editors of Webster's Dictionary yet. Socialism is defined as the means of production being owned and controlled by the state and the products distributed by the state, rather than by private entities or individuals. Nobody is recommending nationalization of the hospitals, drug companies, and medical device manufacturers or drafting doctors.

"Free market" enthusiasts believe for profit insurance is the most effective and cheapest way to pay for healthcare. This is despite the fact Medicare expenses have always been less than 2 to 3-percent (that is 97 to 98 cents of every dollar spent from the trust fund is for patient care). The insurance companies show about a 21-percent expense ratio, and this does not include costs of interactions with hospitals and doctors (generally to delay or deny payment).

We don't have to reinvent the wheel. Of the 191 countries in the world, most have a payment system for healthcare that covers all, for some part, of their healthcare. The advanced nations generally cover basic healthcare and limit only elective type care, such as cosmetic surgery. It is not necessary to adopt any single plan. We can take what we feel is the best of several and leave the rest. We can adapt those to our needs.

One simple solution is to offer Medicare to everyone as a buy in insurance. If the for profits can match the 3-percent overhead, bless them.

Most countries with universal basic care provided out of tax monies allow anyone to opt out and buy either a basic policy, or a supplemental policy. This is all very similar to the seniors buying a supplement to Medicare. Opponents claim this is a slippery slope to "socialized" medicine. I agree, except for the socialized part. The Medicare bureaucrats are much more efficient and cost effective than the insurance companies.

The thing to remember is any reform payment plan will always be a work in process. All countries have problems arise and are constantly fine tuning their programs. Critics will point out all of the problems Canada, the United Kingdom, France and others have with their healthcare payment systems. We have problems also only we can't even call what we have a system. We, and all other countries, have problems and controversies with payments for their military, their schools, their roads, and every other item in their budgets. Why should healthcare system financing be any different?

Note: Medicare expense ratios are taken from Medicare Trustees annual reports to Congress.

Dr. Robert Sauer of Preston is a retired family physician. He can be reached at

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