A UMNS Commentary
By Dr. M. Joycelyn Elders*

June 17, 2009 | LITTLE ROCK, Ark.

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 people.

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 profits.

“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 cost-effective.

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 cost.

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.

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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 newsdesk@umcom.org.

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