In 1994, after the Republicans paralyzed the Clinton health reform proposal, I published an article in the Florida Journal of Public Health titled “Reforming health care in the US and Europe: Why we fail and they succeed.” It explained why health reforms succeed in other Western countries with policies of universal access and user-friendly systems. In our case, the Republicans sacrificed health security of all citizens to play the political game of “Repeal the Obama Affordable Health Care Act,” responding to lobbyists and funding from interest groups. Members of Congress who voted to repeal the law come from the same category of irresponsible politicians who represent special interests that opposed Social Security, Medicare and Medicaid for short political gains.
To review where we are, the American health care non-system:
- is the only system that does not provide health security to its citizens. The uninsured population reached 46.3 million in 2008 (compared to 36 million in 1993) and is steadily increasing. If the status quo continues by repealing Obamacare, it is expected to reach 75 million in 2019.
- is the most expensive system in the world. American healthcare expenditures made up 16.2% of our gross national income in 2008, compared to an average of 9% in Europe. Without the recently passed reforms, it will soon reach 25%, which is almost double the cost in any country of comparable national income. The cost per individual reached $7,681 in 2008.
- has one of the lowest provider-to-population ratios and the highest administrator-to-provider ratios (8 administrators per 10 health providers) among Western nations. The administrative portion of private health insurance agency expenditures is 30%, compared to 2-4% in Medicare and governmental agencies.
- has one of the lowest proportions of hospital beds for the population, the lowest hospital admission rate and the shortest length of hospital stay among Western nations. While European citizens use an average of 7-8 outpatient doctor visits per year, Americans use 3.8 visits per year.
These are just few features of our system that some falsely call “the best system in the world.” By technical and scientific standards, this system is ranked 37th among the 190 countries in the world. Life expectancy at birth, 78 years in the US, is among the lowest of industrial countries. Seven out of 1,000 American children die before their first birthday, a figure similar to that of Thailand and Lithuania. While many are proud of our rate of high-tech surgical procedures, research has demonstrated that about 20% of these procedures are unnecessary and are financially driven or performed to avoid litigation. The scientific measures of quality of care indicate that the American system is, at best, comparable to most Western countries.
Many opponents of the reforms cite concerns such as mandating insurance coverage or government involvement. However, health insurance is compulsory in most developed nations to avoid the costs incurred by individuals who do not pay for coverage and go to emergency rooms for care, shifting the cost to the insured. Also, the notion that the public option will increase government’s involvement in health care is false: about 45% of Americans’ health care costs are covered by governmental programs, including Medicare, Medicaid, Veterans health services, and state and local government services. Another allegation is the cost and the deficit, but this does not take into account the savings for individuals and families from reducing out-of pocket costs, as well as the cost to employers, who will either pay more or will lower health benefits or shift the cost to the employees. Others intentionally confuse the debate by bringing in political ideology or simply targeting the President and the Democratic party. This irresponsible act will hurt all Americans in the future.
It is essential at this time to focus the debate on the health system. To those fighting for repeal, please come with the alternatives first. What will happen to the escalating number of citizens who are uninsured, and those who have preexisting conditions, and the skyrocketing health care cost?
Let us play politics away from the nation’s health security.
Samir Banoob, M.D., D.M., D.P.H., Ph.D., is the president of International Health Management, consulting firm in Florida that leads international health projects and trains scholars from more than 70 countries. He has taught as a professor of international health policy and management and has worked as a consultant to WHO, World Bank, and other international agencies on projects in 76 countries. He served as the Chair of the International Health Section from 1992 to 1994, and again from 2006 to 2008.
It would be nice if, for once, Congress could get health reform right.
In his State of the Union address, Obama all but begged Congress to not walk away from health care reform.1 After the election of Scott Brown to the Massachusetts Senate seat formerly held by the late Ted Kennedy, journalists and bloggers have been declaring reform DOA (or, at best, “on life support”2). Ironically, Senator Kennedy – a champion of health care reform – was replaced by a Republican who broke the Democrats’ filibuster-proof 60-seat majority and derailed the party’s plans to streamline – or, as some might say, ramrod – healthcare reform into law, with or without bipartisan consensus. Since then, Capitol Hill has been quiet. Pelosi has said that the controversial Senate bill does not have the support in House needed to pass it there and put it on the president’s desk.3 Other legislative maneuvers are also being considered, but it seems that, at least for now, members of Congress are letting the dust settle before they figure out their next moves.
While the Massachusetts election has been alternately hailed or blamed for de-railing health reform, it could be argued that the White House and Congress were doing a good job of mangling it during negotiation. What Obama promised would be an open process – “broadcast on C-SPAN,” he claimed in his campaign – turned out to be the same old story of Washington back-room deals. The Senate dropped the public option when Joe Lieberman threatened to withhold his vote.4 Ben Nelson managed to upset everybody when he traded his vote for the “Cornhusker Kickback” – an agreement that the federal government would shoulder Nebraska’s Medicaid burden forever. All this wheeling and dealing, combined with Republicans’ absolute refusal to join in the effort and rumors of “death panels” and “socialized medicine,” has driven public opinion away from the whole convoluted process. A recent USA Today/Gallup poll found that 55% of Americans think that Congress should suspend work on current health care bills and start over.5 By the time it was ready to be reconciled, most of the public had no idea what it even said.
Ultimately, it seems our leaders are perpetually more concerned with being re-elected than they are with doing their jobs – passing legislation. Brown’s victory is the latest in a string of recent Republican victories that are making Democrats up for re-election nervous; now that things are cooling off, many of them are reluctant to re-commit to reform effort. Republicans seem to be more concerned with making Democrats look bad so they can regain control of Congress than with working with them to get something done. Even the president has begun to shift his attention to other issues, such as bank reform, to attempt to regain some popularity.6 Those of us who were so looking forward to reform after both Roosevelts, Truman, Kennedy, and Clinton had all tried and failed7 may be disappointed again.
By Samir N. Banoob, M.D, Ph.D.*
“ The administration inherited a basket of bad apples from its predecessor: the budget deficit, the recession, a week economy and unemployment to mention a few. Among the problems, the health care crisis is the worst by far”
This quote is not recent since I published it on February 7, 1993 in the St Pete Times, an article titled “Health Care: Painful Remedies are needed”
I was referring to the Clinton administration and the President’s promise to produce his Health Security act within the first administration 100 days. As a reminder, at that time Republicans raised the issues of big government, increasing the deficit, government taking over health care, eliminating choices, more taxation, hurting the private sector and the rest of the same old story. Moreover, they introduced 6 more health plan proposals to the Congress until the whole reform issue faded away and was dropped. This was paralleled with an aggressive heavily funded campaign lead by the Republican Party, insurance companies, the pharmaceutical industry and others. Since then, and until 2008, every Democratic presidential candidate, learning the lesson the hard way, dropped the health insurance and universal coverage from his agenda.
In 1994, I published an article in the Florida Journal of Public Health (vol VI, no1) on “Reforming Health Care in the US and Europe: Why we Fail and They Succeed? “ It said: “Why health reforms succeed in all western countries? They established concrete health policies of universal access and user-friendly systems in the 30s and the 40s, guided by a solid commitment to national welfare and social solidarity. Second, the voice of interest groups is not so loud, and if it becomes so, its impact on policy-making is minimal since policy makers’ behaviors are put under stringent scrutiny of their well-informed voters. Third, the government and the elected representatives, who are elected by the watchful voters, are more trusted, and the government is allowed to govern, and elected representatives make decisions in the public interest”
– * Samir Banoob, M.D, D.M, DPH, Ph.D. is a professor of international health policy and management and consultant to WHO, World Bank and international agencies who consulted with 76 countries.