Angell On National Health

What stance can a person take toward a system that does superbly well by him, but fails to serve the needs of huge numbers of his fellow citizens and residents of the United States?

That’s my situation with the American health care system. For many years, I have had the good fortune to be well served by medical professionals, and I much appreciate their efforts on my behalf. And now, thanks to Medicare, I share in a system that assures my age peers and me some financial support for our care.

At the same time, I feel acutely conscious of the millions who lack access to the current system or who fail to get first-rate care. And I am also aware of deficiencies in my own health care plan:  in the event of a long lasting chronic illness, I could face a crisis as well.

So I stand convinced of the need for radical change in the structure by which health care is delivered in this country. In fact, I find it hard to understand how we have tolerated a system that for decades has shown itself inadequate. To me it continues to be a scandal that we allow so many to go without, when our capacity for excellent health care has been long demonstrated.

My views were recently confirmed when I heard Marcia Angell outline the case for a national single-payer system to replace our current seriously flawed approach.

A physician whose many credits include editorship of the New England Journal of Medicine, Dr. Angell is an authoritative and persuasive speaker.

We speak of our current arrangements as a system, but the term is inadequate. Rather, in Dr. Angell’s words, it’s a “hodge-podge of different business arrangements that exist more or less independently from one another.”

As she sees it, three major problems characterize the status quo in health care. First, it is “staggeringly expensive.” Furthermore, despite that expense, “we don’t get anywhere near our money’s worth.” Finally, among the world’s 30 richest nations, ours is the only one that relies on a market approach that bases eligibility on ability to pay, rather than making sure that everyone is included.

Some argue that letting the market work harmonizes with the American way of doing things; but they ignore crucial facts. The most important of these facts is that those least able to pay are usually the ones most in need of health care. In fact, cost shifting stands out as one of the salient features of the current system. As much as possible, insurers try to impose as many costs as they can on patients. This they do by deductibles, co-payments, and denial of some treatments.

Dr. Angell explains: “There’s a great mismatch between medical need and the ability to pay.” Why should the lack of money deprive people of such a basic human need as good health?

Polls suggest that as many as two-thirds of Americans favor changing the current system and putting in place the single-payer model. But two major vested interests continue to stave off any such change. The insurance and pharmaceutical industries, both titans in the political sphere with lots of money and influence, have thus far succeeded in blocking proposals for a new approach.

Dr. Angell holds that one way these huge corporations succeed is by fostering myths about health care. They claim that single-payer would cost more, quite the opposite of what studies show. They also want us to believe that long lines for treatment would result and that new technologies would be unavailable.

Another ploy is to call a national plan “socialized medicine,” with the suffocating bureaucracy that many people attach to this name. The opponents of single payer also rely on the cliché that government cannot do anything right. And, finally, they would have us believe that single-payer plans have no place in the real world.

Dr. Angell sees her proposed system as a way of reducing the gap in our society between the haves and the have-nots. That gap has been growing larger and thus creating fissures in our national community, divisions that damage the vital interests of  rich and poor alike.

Desperately needed as it is, I have no great hope that national health insurance will be enacted any time soon. However, I do believe that a promising sign is the difficulty that some large corporations are experiencing in paying to insure their current employees and those who have retired.

General Motors recently felt forced to ask its largest union to accept cuts in the health coverage offered to its retired workers. Significantly, the union accepted the company’s proposal without notable protest, recognizing that GM’s increasing costs do count as an insupportable burden.

Ideally, the time will come sooner rather than later, when the corporations will exert their power to press for scrapping the current system and instituting a single-payer plan. Until that time comes, we are going to see inexorable rises in costs without any corresponding inclusion of those left outside in the cold.

Richard Griffin