Footnotes
Readers are encouraged to respond to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu
letter . 2007 May 4;9(2):27.
letter MedGenMed. 2007 May 4;9(2):27.
To the Editor:
I am pleased to see coverage of a central dilemma of our time: THE HEALTHCARE MESS!
While I agree with several of the shortcomings Ms. Turner noted about the California proposal, the third item: “For taxpayers: Existing public programs will be expanded to insure children well into the middle income ranges – those in families earning up to $60,000 a year.”[1] seems to me to be one aspect they have addressed appropriately. It would be a step toward true universal coverage.
Across the country, legislative agendas are crowded by multiple bills with confusing titles; often, it is difficult to tell exactly who is supporting the thorough, inclusive reform necessary. Many proposals feature cost shifting that does suggest a “shell game,” perpetrated in large part by the medical insurance establishment. We need to address the inflated cost of health insurance as well as the uninsured people and the dilemma for employers. A major impediment to addressing all facets of the issue is the pessimistic views of some senior legislators who assume that “it cannot be done,” since bold proposals have previously been squelched.
The time is NOW to recognize that a publicly financed, single-payer system, with individual freedom of choice of providers, offers the fiscally responsible solution to ensuring healthcare for ALL. It will avoid the indignities of means-testing, supervision of private health issues by employers, averse selection decisions by insurance carriers, as well as the estimated 20% extra overhead when cumbersome intermediaries are required.
We are pleased to see that the entrenched special interest groups are increasingly countered by voices from the people and hope you will recognize that in future commentary. We ask you to look carefully at the proposals and then demonstrate the LEADERSHIP we expect from MEDSCAPE.
Sincerely,
Reference
- 1.Turner GM. California and Universal Health Coverage. Medscape General Medicine. 2007;9(1):36. Available at: http://www.medscape.com/viewarticle/551829. Accessed February 23, 2007. [PMC free article] [PubMed] [Google Scholar]
MedGenMed. 2007 May 4;9(2):27.
Dr. John Garland wrote to Medscape to praise you for highlighting the serious problems in our healthcare system, from the high cost of health insurance to the millions of people without health insurance. I agree that bold measures are needed to address these very serious problems.
Unfortunately, however, the prescription that Dr. Garland offers is a single-payer, taxpayer-financed healthcare system. But a quick glance at systems around the world shows that socialized medicine has serious flaws of its own.
State-administered systems always fall victim to laws of supply and demand. In a healthy marketplace, consumers determine what they're willing to pay. But in a price-controlled system, bureaucrats and politicians make those decisions instead. It is a utopian dream to believe that government would not intervene in directing and limiting choices by doctors and patients.
Case in point: Two new “wonder drugs” with the potential to prolong the lives of thousands of kidney cancer sufferers are being denied to patients in the British socialized healthcare system because they are too expensive.
The drugs have proven to shrink tumors dramatically, with some cancers disappearing altogether. The drugs have been licensed for safety, but the British government agency that approves payment for new drugs so far has declined approval.
In the interest of national budgets, state-administered health systems have an incentive to put saving money before lives.
This creates a serious discrepancy between what's needed and what's provided – including the ratio of doctors to patients. Japan, for example, spends only about half as much of its gross domestic product on healthcare as the United States. But the resulting low salaries that doctors receive have caused a deadly shortage of cancer specialists in a country where the disease is the leading cause of death.
Defenders of European-style healthcare will often observe that the United States spends a greater percentage of its GDP on healthcare than any other country. But these arguments fail to take into account actual access to care. A report by the Canadian Fraser Institute found that the average wait time from referral by a general practitioner to a specialist is 18 weeks, the longest ever recorded in Canada.
The best healthcare decisions are made by patients and their doctors, not by the government – as Dr. Garland certainly would agree. That's why the solution to America's healthcare costs doesn't lie with expanded public programs. Instead, it lies with creating a uniquely American system grounded in proper greater incentives, more affordable choices, and expanded access to private health insurance through a fairer, more equitable distribution of subsidies.
In a nation that loves choices, a one-size-fits-all, top-down single-payer system just won't sell.
