By Frank Wessling
This was written before President Obama’s televised speech this week on reform of our health care system. What he has said may help get our national conversation on this topic back on a useful track where the moral issue of equitable care for everyone is the priority.
Let’s hope so. We should be ashamed of ourselves if squabbling over side issues and diversions like phony “death panels” wreck this effort.
Any changes to our system will affect both the way medical care is delivered and the ways we pay for it. Some Americans insist on saying that what we have is the best in the world, so why change. But we simply aren’t the best. We may have some things that are the best in the world, but the evidence is clear that many countries do better in making sure that all citizens get the care they need without the worry of personal bankruptcy over cost.
We can do better if false pride doesn’t get in the way.
Part of the problem we have is that we ignore examples of what a better system might look like. We know too little about how things actually work in other places. In Germany, for example, everyone signs up for medical insurance with a choice of about 200 insurance plans run by private companies. Switzerland operates the same way. Choice of doctors is up to the individual and costs are far less than ours. Isn’t there something here for us to learn?
Medical care in such countries is available as needed, although non-emergency procedures may require waits. But many countries, including Germany, Austria, Britain and Japan, beat the U.S. on wait times for appointments. In Japan, it is usually possible to see a medical professional the day of a call. And the Japanese, whose average age is older than ours, use medical care at a rate three times that of the U.S with lower cost. They put out only $3,400 per person per year compared to our expenditure of more than $7,000 per person.
How is this possible? Better care for much less money in a system using private enterprise?
There are two interrelated reasons to begin with: Everyone is in the insurance pool of every insurer, with no cherry-picking to eliminate poor risks; and, largely as a result, the insurance companies operate much more efficiently. U.S. health insurance companies spend about 20 cents of every dollar for such things as paperwork, reviewing claims and marketing. Canada’s government-run system spends 6 percent on administrative costs. In France, the private health insurance companies average about 4 percent. In Taiwan, a system managed by the government spends only 1.5 percent of its money on administration.
The way medical professionals are paid is also a driver of both our cost problems and the availability of needed care. A shortage of primary care physicians is affecting this country, and one of the reasons is the way we compensate doctors. The money stream is stronger for specialists and for exotic procedures and use of technology. As American medical care shifted from a vocation and mission to a business model, the family doctor who consults and advises and spends time on the common bumps, bruises and illnesses of life wound up at the low end of the income curve.
The system of payment should be changed so that primary care is better compensated — and with incentives to encourage more attention to good health habits.
The national conversation about our medical care system has sounded like a schoolyard shouting match lately rather than a reasoned discussion. Claims of “socialism” are simply a bogeyman to scare us away from serious looks at alternatives to what we do now. There are lessons to be learned everywhere. But the future quality of life here depends on our ability to be open-eyed learners today.
Catholic teaching sees health care as a basic human right. In the United States we currently compromise that right by basing it too much on ability to pay. We further compromise it by allowing such a high diversion of funds from health care itself to business overhead and advertising. As we come to know these things, at some point it becomes a moral imperative to make changes so that every person is able to obtain needed care with dignity — without fear of bankruptcy.
That is a reachable goal, and one that would truly push us into best-in-the-world class.