If America's So Great, Where's Our Health Care?

By Sarah Ruth van Gelder and Doug Pibel, YES! Magazine. Posted September 23, 2006.

For Joel Segal, it was the day he was kicked out of George Washington Hospital, still on an IV after knee surgery, without insurance, and with $100,000 in medical debt. For Kiki Peppard, it was having to postpone needed surgery until she could find a job with insurance -- it took her two years. People all over the United States are waking up to the fact that our system of providing health care is a disaster.

An estimated 50 million Americans lack medical insurance, and a similar and rapidly growing number are underinsured. The uninsured are excluded from services, charged more for services, and die when medical care could save them -- an estimated 18,000 die each year because they lack medical coverage.

But it's not only the uninsured who suffer. Of the more than 1.5 million bankruptcies filed in the U.S. each year, about half are a result of medical bills; of those, three-quarters of filers had health insurance.

Businesses are suffering too. Insurance premiums increased 73 percent between 2000 and 2005, and per capita costs are expected to keep rising. The National Coalition on Health Care (NCHC) estimates that, without reform, national health care spending will double over the next 10 years. The NCHC is not some fringe advocacy group -- its co-chairs are Congressmen Robert D. Ray (R-IA) and Paul G. Rogers (D-FL), and it counts General Electric and Verizon among its members.

Employers who want to offer employee health care benefits can't compete with low-road employers who offer none. Nor can they compete with companies located in countries that offer national health insurance.

The shocking facts about health care in the United States are well known. There's little argument that the system is broken. What's not well known is that the dialogue about fixing the health care system is just as broken.

Among politicians and pundits, a universal, publicly funded system is off the table. But Americans in increasing numbers know what their leaders seem not to -- that the United States is the only industrialized nation where such stories as Joel's and Kiki's can happen.

And most Americans know why: the United States leaves the health of its citizens at the mercy of an expensive, patchwork system where some get great care while others get none at all.

The overwhelming majority -- 75 percent, according to an October 2005 Harris Poll -- want what people in other wealthy countries have: the peace of mind of universal health insurance.

A wild experiment?

Which makes the discussion all the stranger. The public debate around universal health care proceeds as if it were a wild, untested experiment -- as if the United States would be doing something never done before.

Yet universal health care is in place throughout the industrialized world. In most cases, doctors and hospitals operate as private businesses. But government pays the bills, which reduces paperwork costs to a fraction of the American level. It also cuts out expensive insurance corporations and HMO's, with their multimillion-dollar CEO compensation packages, and billions in profit. Small wonder "single payer" systems can cover their entire populations at half the per capita cost. In the United States, people without insurance may live with debilitating disease or pain, with conditions that prevent them from getting jobs or decent pay, putting many on a permanent poverty track. They have more difficulty managing chronic conditions -- only two in five have a regular doctor -- leading to poorer health and greater cost. The uninsured are far more likely to wait to seek treatment for acute problems until they become severe.

Even those who have insurance may not find out until it's too late that exclusions, deductibles, co-payments, and annual limits leave them bankrupt when a family member gets seriously ill.

In 2005, more than a quarter of insured Americans didn't fill prescriptions, skipped recommended treatment, or didn't see a doctor when sick, according to the Commonwealth Fund's 2005 Biennial Health Insurance Survey.

People stay in jobs they hate -- for the insurance. Small business owners are unable to offer insurance coverage for employees or themselves. Large businesses avoid setting up shops in the United States -- Toyota just chose to build a plant in Canada to escape the skyrocketing costs of U.S. health care.

All of this adds up to a less healthy society, more families suffering the double whammy of financial and health crises, and more people forced to go on disability. But the public dialogue proceeds as if little can be done beyond a bit of tinkering around the edges. More involvement by government would create an unwieldy bureaucracy, they say, and surely bankrupt us all. The evidence points to the opposite conclusion.

Sarah van Gelder is Executive Editor of YES! Magazine. Doug Pibel is Managing Editor of YES!

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