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Reforming Our Health Care System

01/08/02 12:00AM

This is the year we can expect new proposals to improve our health care system. A number of commissions and groups have been studying ways to do that. But one reality that faces these panels is that in the United States, we have no organized health care system to reform.

Americans have no right to health care. There is nothing in our constitution or in federal law that guarantees health care to all citizens. This surprises some people, since polls show most of us think of health care as a right. But what we have is a loose collection of free-market services, non-profit organizations, Federal and state programs, and community services. Even though we have some of the best health care services in the world, they can hardly be called a system.

Our access to health care depends on our ability to pay. Usually, that depends on our access to health insurance, and our ability to pay out of pocket for everything the insurance doesn't cover. And here's our core problem. Americans have uneven access to care, uneven quality, and widely varying costs. We have poor, uninsured populations in every state. Even with Medicare, we have old people who cannot pay for the care they need. Many hard-working, prime-of-life Americans cannot afford health insurance.

Yet we have the highest costs in the world. Americans spend 13.6% of our Gross Domestic Product on health care. Compare this to 6.7% in England, 7.6 percent in Japan, and 10.6 percent in Germany.

So our care is the most expensive, but do we have the best?

For those who can afford it, the U.S. has the most advanced technology and the most highly trained physicians in the world. But national health care studies show that those with no insurance or low coverage experience starkly inferior care.

The United States is the only major example in the world of a private health insurance system in which many health care services and insurance companies are profit-driven. Whether or not we choose to change that, we ought to take a closer look at how other countries meet their health care needs and pay the bills.

For example, England has a tax-paid system. All citizens have health care at half the cost Americans pay. But the government controls every aspect of the system. Access can be limited. Some treatments and tests can be denied or delayed.

In a third kind of system such as those used by Germany, France and Japan, social insurance pays the bills. These countries offer examples of health care managed by not-for-profit quasi-public insurance carriers. They have responsibilities similar to U.S. insurers but they are tightly controlled by government. The national health ministry dictates coverages and premiums. Their costs are mid-range, more than England's, less than ours. Everyone is covered. And health care services are generally not restricted.

Here, with no real system and no fundamental right to control free-market, privately owned services like nursing homes or physician practices, or products like prescription drugs, health care reformers are limited. We can expect to see more tension between providers and regulators. There will be more attempts to provide for populations in need at taxpayer expense. Those struggles will be about money. Those of us interested in improving our health and the quality of our health care, will need other strategies.

--Peg Devlyn is co-owner of Marketing Partners, Inc. in Burlington, Vermont.

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