| Last week, Bernie Sanders introduced the American Health Security Act of 2009. You can view the bill here. This, folks, is actual Universal Health Care. There's a slight twist, in that it would initially be run as 51 separate programs in each of the states and the district, but would eventually be nationwide. The plan encompasses care for everyone, starting with getting one's health card at birth, as everyone now gets a Social Security number at birth. The bill is 172 pages, which is why it has taken me since last week to post it, that old "had to read it first" dedication....and if YOU read it, you'll see that the care is comprehensive: medical, dental, behavioral. You'll also see that he also covers funding, cost containment, and one other thing that most people tend to forget: GETTING providers. If you live in a major city, especially one with a number of teaching hospitals, there are lots of doctors. Not so true in rural areas or poor areas. The Senator represents a mostly-rural state, and would like Vermont to be one of the pilot locations. From his web site: With more than 47 million Americans without health insurance coverage, it is clear that we need major changes in our country’s health care system. But, health care coverage will not be enough to assure access to care. Over 55 million Americans, insured and uninsured, have trouble finding a primary care provider. That is why Senator Sanders has proposed a comprehensive set of proposals that will assure not just insurance coverage, but will increase the number of health professionals and community health centers to enable all Americans to receive affordable medical, dental, and behavioral health services. Senator Sanders is a strong advocate of a single-payer health insurance system that would be administered at the state level. He has introduced legislation that would provide funding and incentives for five states to experiment with a variety of methods to cover all state residents. Through these experiments, Sanders believes the single-payer approach will be proven to be the most cost-effective program and will expand nationally. You should note that this bill is the first Senate bill for true universal care since the one Paul Wellstone introduced in 1993. So much has changed since Senator Wellstone died in that plane crash, but a one thing ha not: all Americans still need health care. There is a companion bill in the House, HR 676. It was introduced last session with over 90 co-sponsors and a long list of endorsements, and has been reintroduced this session by John Conyers. It even has its own web site. Unlike the Baucus bill, and other health care proposals ruminating around Congress, this one actually provides health care, and answers to the problems of an incredibly broken system. |
Our health care system is irrevocably broken. It isn’t even a health care system; it is a “sick care” system.
We are currently 46th in life expectancy, out of 223 countries. We spend more per capital on “health care” than anyone else.  One can look at reams of data, and the conclusion is irrefutable: something is very, very wrong. Throwing money hasn’t made us healthier, instead it makes us dead.
So what’s actually wrong with our health care system? We have high tech, we have drugs, we have doctors, hospitals, clinics, doc-in-a-box, programs, insurance, a Public Health Service and the largest medical research budget around, but somehow, it isn’t working.
I contend that the fundamental problem is that our system is dedicated to profit. No profit-oriented system will ever focus enough on outcomes, prevention, nor cure. An incredibly simple example:
Cardiovascular disease (heart attack, stroke, high blood pressure) has been the leading cause of death in the United States for more than 80 years. One of the first markers for CV disease is high blood pressure, often called “the silent killer” because it initially has no symptoms. Currently, most doctors initially treat primary hypertension with a beta blocker and an ACE inhibitor. They recommend changes to diet, exercise, smoking and stress reduction, but they are only suggestions.
Studies indicate that there would be an identical outcome with the use of simple diuretics in lieu of the far more expensive beta blockers and ACE inhibitors, but the prescription rates are far lower. Why? Drug companies push the “latest and greatest” and they haven’t made money on Lasix for years.
The problem is the number of people who work the “health care system” with an eye to profits.
Start with the insurance companies. Most are privately owned, and are therefore responsible to their stockholders, not their policy holders and certainly not their patients.
In addition, the majority of health insurance policy holders are not the individuals who receive services, it is other major corporations and mid-sized businesses. Therefore, the goal of the actual policy holders may not be health care, but holding down costs. When companies with more than 250 employees (sometimes 500 depending on the insurance company) set up their insurance plans, they have the option of paying premiums, or sharing risk with the insurance companies in terms of whether premium dollars paid will be more or less than the amount of service dollars paid out. Health care is often one of the largest costs to companies after straight salary. Once a company provides its employees with health insurance, its concerns relate to holding down the amount paid for claims relative to their share of the premium cost, especially where there is shared risk.
The next profit motive comes from the drug companies. I don't even have to say anything: you know what drugs cost. Viagra (and its ED brethren) is one of the most common drugs in use today. How much less do you think it would cost without what they're paying out for Super Bowl ads? And let’s not forget the device manufacturers, the advertising companies, and the companies that provide no medical services, but make profit off the process. These include, but are not limited to, companies that help patients figure out hospital charges, companies that help doctors figure out if they are being overcharged by .1% on their credit card billings, insurance brokers, malpractice attorneys, and slip-and-fall attorneys. The Wellstone Plan, the Sanders Plan, the Conyers Plan...THIS is how we make health care "health" care, instead of sick care. This is how we build a better system that cares for everyone, this is how we reduce mortality and morbidity and increase life expectancy. For those that buy the 30-second ad version of "but it doesn't work in [name your country]"... if it works so poorly, how come they live so much longer?
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