NEW YORK NURSE: October/November 2007
by Nancy Webber
The urgent need for national healthcare reform was brought into focus at a Convention plenary session by Steffie Woolhandler, MD, co-founder of Physicians for a National Health Program (PNHP) and an associate professor at Harvard Medical School.
At the start of her talk, Woolhandler quickly listed the now-familiar statistics that illustrate the nation’s worsening healthcare crisis:
At least 47 million people in America are uninsured and nearly 13% of the nonelderly uninsured are veterans.
More than 18,000 people die each year because they lack health insurance.
About half of the personal bankruptcies declared in the U.S. are due to medical costs; 76% of those individuals had insurance coverage when their medical emergencies first struck.
The nation’s economy is also feeling the effect of spiraling healthcare costs. To cut costs, manufacturers are moving their operations to countries where the government provides health coverage rather than employers.
“My Ford minivan was made in Canada,” Woolhandler said, “because the healthcare costs that go into cars made in America are higher than the cost of the steel. We’re also seeing the ‘Walmartization’ of America – an increase in low-paying jobs without health benefits.”
Although the United States has the most expensive healthcare system in the world, at an annual cost of nearly $6,000 per person, this does not buy Americans the best quality care. According to the World Health Organization, the U.S. is 37th in the world health rankings.
At the root of these dual problems of high cost and low quality is healthcare coverage that is mostly provided by privately owned, for-profit health insurance companies. “Privately owned HMOs provide lower quality care because they divert resources from patient care,” Woolhandler said. At Aetna, for example, more than 23% of revenues are used to cover overhead expenses such as executive pay and shareholder dividends.
She also had a response to the common argument that a “Canadian-style” healthcare system would make it harder for people to get care. She said that in Canada, 10.7% of patients had unmet health needs, compared to 10.3% of insured patients in the U.S. She acknowledged that, due to reduced funding and the closing of hospital beds in Canada in the 1990s, access to care worsened during that period.
“The system was good. The funding was bad,” Woolhandler said. A primary care physician at Cambridge Hospital in Massachusetts, she said she has seen maybe a dozen Canadians intentionally seeking care in the U.S.
Woolhandler went on to criticize healthcare reform proposals that do not include a single-payer insurance plan. Consumer-driven health plans, which include health savings accounts, are “junk insurance,” she said.
“People spend all the money in their savings accounts and then they enter a doughnut hole, where they have to pay out of pocket until catastrophic coverage kicks in,” she said. “It’s bad economics because it doesn’t encourage preventive care and does nothing about high-cost cases.”
She was equally critical of the “Massachusetts model,” endorsed by some Presidential hopefuls. Under that plan, people are required to have health insurance, like drivers are required to have car insurance. The state will provide low-cost insurance plans for those who can’t afford to pay for private insurance.
There are a couple of problems with that idea, according to Woolhandler. “This has been tried in several states, and they have not worked,” she said. “The number of uninsured has not gone down. And these plans don’t do anything to reduce hidden costs for people with insurance.”
“Pouring more money into a broken system is not the answer,” Woolhandler concluded. “A single-payer system captures the money that is now being spent on the administrative costs of an inefficient, patchwork system. It’s time for our leaders to stand up to the political and financial power of the insurance industry.”