|Commentary: U.S. needs health care vs. sick care|
A UMNS Commentary
By Dr. M. Joycelyn Elders*
June 17, 2009 | LITTLE ROCK, Ark.
Dr. M. Joycelyn Elders
The United States has the best “sick care” system in the world, but
our “health care” delivery system is lacking. We have the best doctors,
the best hospitals, best academic health centers, best nurses, the best
drugs, and we are leaders in research.
Our problem is that the system is not available to all of our
citizens. In addition, our health care is not equitable, coherent,
comprehensive and cost-effective, nor do we have choice. The United
States has 5 percent of the people of the world and 25 percent of the
world's wealth. We are the richest country in the world and the only
industrialized country that does not provide health care for its entire
Health care, which now consumes 17 percent of the U.S. Gross
Domestic Product, or $2.4 trillion in 2007, continues to grow in its
appetite for our economic resources, while the United States continues
to fall in overall health care for its citizens in comparison with the
remainder of the industrialized world.
We do not have the best health, ranking 46th in life expectancy,
42nd in infant mortality and 57th in overall goodness and fairness as
compared to 192 other members of the Organization for Economic
Development and Cooperation.
If the rest of the industrialized world can manage to serve all its citizens on less, why can we not?
Lives at risk
The lack of access to health care for so many is literally bankrupting our people and endangering all our lives.
We have depended upon employers to carry much of the burden of
health insurance over the years. However, now we find in this global
economy that they are at a disadvantage trying to compete with
countries that have a public health care system. Health insurance
expenses are the fastest-growing cost component for employers. Unless
something changes dramatically, health insurance costs will overtake
“We are the richest country in the world
and the only industrialized country that does not provide health care
for its entire people.”
President Obama’s desire for a health care plan is one that improves
coverage for the 45 million to 50 million uninsured citizens, contains
costs, and offers high quality, cost-effective, equitable, portable and
affordable care for everyone.
We must simultaneously address, integrate and solve the three major
components of health care reform: Financing, organizing the delivery
system, and educating patients and community, in order to facilitate
behavioral and lifestyle changes.
Quality of care would improve if every patient had access to a
medical home and an accountable care organization with electronic
medical records where care was patient-centered, coordinated and
Monitoring of many of our procedures, techniques, new technologies
and drugs needs to be evaluated. We need to replace our inefficient,
inequitable financing system with one that works. It needs to include
everybody with subsidies for the young, poor and sick. It must require
all to pay their fair share.
Physicians must have the information (electronic medical records),
infrastructure and incentives they need to improve quality and control
Physicians, heal this system
Physicians must become involved in population health. Health is
influenced by factors in five domains, which are genetic, social
circumstances, environmental exposures, and behavioral patterns and
health care. The single greatest opportunity to improve health and
reduce premature death lies in personal behavior.
On an individual level, we can do more to improve our own health than all the medical discoveries in the past 100 years.
We must dream big; our vision is for healthy people in healthy
communities with a health care system that is right for all of our
citizens. It needs to be available, affordable, accessible,
patient-centered, prevention-focused, purpose-driven and
solution-oriented. It must empower individuals to take care of
themselves, foster responsibility and human dignity, improve health and
enhance quality of life.
Any new health care system must contain a provision for a public
health care policy; this is a single-payer system. People who prefer
private insurance can always purchase it instead of purchasing a public
health care policy. In this public health care policy, we must provide
every person with access to basic health care, including physical and
cultural access through transportation and language sensitivity.
We also must provide education to promote health maintenance,
preventive measures in order to thwart disease, basic dental health
care, mental health care, emergency services and necessary medicines.
A public option
Ask Medicare patients if they would like to give up their insurance
and I think few would answer in the affirmative. Public health care is
well liked in the United States. People who do not receive Medicare may
not know that each person pays almost $100 per month for the insurance,
which is deducted from Social Security checks automatically. After a
yearly deductible, Medicare pays 80 percent of most medical care but
not dental care. There is a prescription Medicare (Part D) that is
separate from other Medicare and has a variety of plans.
“ The lack of access to health care for so many is literally bankrupting our people and endangering all our lives. ”
A public health care policy would likely be similar to purchasing
Medicare. With Medicare, about 98 cents of every dollar paid in payroll
taxes are spent on actually providing health care. When you look at the
private insurance companies, it is more like 80 cents. The rest goes to
administrative expenses and profits. There are many additional costs
imposed on the doctors and health care providers themselves, who have
to deal with a fragmented, complex system in which they have to
negotiate, amend, or cajole payment from many different insurers.
Both business and individuals are breaking under the strain of our
very expensive health care system. We must overhaul our system now; its
condition is beyond tweaking to make it function for our people. We
have tried to tweak the way we perform health care for many decades
with disastrous results. We have tried HMOs, PPOs, indemnity with an
assortment of public health systems to catch some of our people who
fall between the cracks. It has failed while costing us precious lives,
health and money of our people along the way.
We need an overhaul of the health care system to save lives, money and American business.
*Elders, a United Methodist, served as the U.S. surgeon general
under President Bill Clinton from 1993 to 1994. She received degrees
from United Methodist-related Philander Smith College
in Little Rock, Ark., as well as the University of Arkansas Medical
School. She is currently professor of pediatrics at the University of
Arkansas Medical Center in Little Rock.
News media contact: Tim Tanton or David Briggs, Nashville, Tenn., (615) 742-5470 or firstname.lastname@example.org.
Healthcare for Uninsured
Free Heart Clinic
Healthcare For Hispanics
Taking chance of a lifetime for health care
All Americans need health safety net
Pray, work for universal health care
Family physicians vital to health care reform
Time is now for health care reform
Church welcomes free health clinic
The long and winding journey of Dr. Joycelyn Elders
Then & Now: Joycelyn Elders
On balance, President Barack Obama's health-care reform plan is promising
Q+A-Where does healthcare reform stand in US Congress?
Edelman urges health care coverage for all children
Healthy Child Campaign seeks coverage for all kids
Agency focuses on centennial, health initiatives
Joycelyn Elders, MD-Resume
Dr. M. Joycelyn Elders biography
United Methodist hospitals and health care facilities
Right to health care
Four areas of ministry focus
Global Health Initiative
Comments will be moderated. Please see our Comment Policy
for more information.