In considering the complex nature of health care, the two basic components that make up its function are quality and affordability.
Quality of U.S. health care could be improved but the burning issues are access and affordability. If we as a nation could afford health care, almost everyone would have access to it.
Yet a basic actuarial payment disconnect exists. Almost every American has access to emergency life-saving care and frequently some form of safety net treatment, yet a significant number of people for a variety of reasons will not pay in to help defray the costs of that care
All U.S. citizens deserve access to our excellent health care system. Key reasons include improved quality of health for all and the obvious humanitarian reasons. The struggle is how to make this happen without totally bankrupting the government and brining the private sector to its financial knees, which is where we are headed now even without adding in the 35 million-plus Americans now under- or uninsured.
But we can pull it off if we can set aside certain biases that are the bedrock of strong opinions on way or another.
1) We need to give up the term "socialized medicine." It is pejorative while having no agreed-upon definition. It was coined to combat the introduction of Medicare and has stuck ever since. It's a fact the government and the private sector are and have been inextricably entwined in healthcare for decades.
Fact Box
Dr. Clyde Nash of Boca Grande, professor emereritus at Case Western Reserve University School of Medicine and the MetroHealth Medical System in Cleveland, can be reached at (216) 554-2070.
2) Competition is not the panacea to cure all health care woes, Health care costs have continued to soar for decades despite the applicant of this concept basically because competition led to costly duplication and triplication of resources as systems compete in the same region for the same patients. This has added significant costs while frequently leading to an overall inefficiency and underuse of additional resources purchased.
3) Medicare is by far the most effectively run and has the lowest overhead cost of management of any system. Like it or not, Medicare is a single-player system. Ironically, practically every physician and health care provider system has now come to recognize the benefits of such an approach.
The ongoing nightmare is every insurance company and payer of health care services has its own set of rules governing who gets what care paid for under what set of circumstances - let alone which panel of doctors and hospitals they can use.
This blizzard of contract rules is a plaque on any health care provider trying to cover costs efficiently.
Hundreds of extra personnel are needed to sort out the myriad complexities thrown up by each entity that proposes t pay the health care costs of its clients.
In addition, the management costs for private and non-Medicare health insurance entities is at least double to triple that of Medicare, this adding seriously to the overall costs of health care.
Anyone who has ever looked at the medical bills generated by the system that has delivered the care, i.e., an emergency room visit, an operation or a critical care unit, cannot help but be stunned, appalled and bewildered.
The outrageous costs presented in the bills have nothing to do with what the third-party payer will pay and what the health care provider will accept. It is all determined by the particular contract between the provider and the payer - essentially leaving the patient out of the loop, of course, unless he or she has no insurance coverage whatsoever.
Those without insurance are expected to pay the full, inflated costs the provider does not expect to receive anyway. How absurd is that! We can - and must - do better.
Medicare is the single fee structure that is constant for all providers who accept Medicare payments. It is spelled out for all Medicare patients so all providers know what the contract is and can organized accordingly or this large block of patients.
This is why the cost to manage this system is low, somewhere below 10 percent.
Add to this there are no restrictions to the patient in choosing a doctor or hospital or having coverage that will not be denied for medical reasons anywhere in the United States. This is why seniors almost universally like their Medicare and why many feel the best solution would be to somehow expand the Medicare format to include citizens of all ages in this efficient single-payer system.
