Adding insult to injury

The U. S. ranks 37th in overall quality of health care.

By Ralph Nader

The 180 million Americans with health insurance got a victory this past June when the U. S. Senate adopted a long-sought set of rights for patients.

The legislation establishes federal standards for private health insurance, including that provided through Health Maintenance Organizations (HMOs), and allows patients to sue in federal and state courts to enforce their rights. In California, a similar state law providing the right to sue has proven a major deterrent to reckless denial of treatment by HMOs.

As one of the bill's key sponsors-- Senator Edward Kennedy Ð commented: "This is a giant step forward in giving power to the powerless."

But left out of the celebration about patients rights are 45 million citizens who have no health insurance. They remain the powerless in a scary world where even a relatively minor illness or injury can mean economic disaster and where preventative medicine, like a physical checkup or blood test, is an unaffordable luxury.

Even if patients' rights survive in the House of Representatives and avoid a Presidential veto, health care in the United States remains a disgrace. We spend more on health care per capita than any other nation in the world -- often double that of nations in Western Europe who cover all their people. Yet, the World Health Organization ranks the U. S. as 37th in overall quality of health care.

Access to health care is distributed unequally among the rich and the poor.

While 11 percent of whites lack health care insurance, the disparities are even greater among the minority populations where 21 percent of African-Americans, 21 percent of Asian-Americans, and 33 percent of the Hispanics lack health insurance. More than 29 percent of young people between the ages of 18 and 24 are without any form of health insurance.

Many of the 200 million citizens counted among the insured are actually "under insured" with limited policies which often cover only catastrophic injuries or provide exclusions for a long list of health problems. There are serious gaps in many health policies that leave the insured with little or no coverage for prescription drugs, medical supplies, vision, or hearing care. And many policies require large out-of-the-pocket "co-payments" from the insured which make care unaffordable for low and moderate income families.

We can do better as a wealthy nation. Every other industrialized nation provides comprehensive care for its citizens and at a lower cost than our system which leaves so many people out. Other nations spend between six and ten percent of their gross domestic product (GDP) on health care while the U. S. spends 14 percent of its GDP on health care -- much of it going to insurance company overhead, unnecessary (and often padded or fraudulent) billing and administrative costs, huge profits, and bloated executive salaries at large HMOs and other health care companies.

We need to face up to the need for a national health insurance program -- a single-payer system ("full-medicare for all") that would provide better and more affordable care for all citizens. Studies have shown that savings from a single-payer system would be more than enough to allow the nation to provide high quality comprehensive health benefits for all Americans.

Under a model plan developed by the Physicians for a National Health Program (PNHP), the program would be federally financed and administered by a single public insurer at the state or regional level.

Premiums, co-payments, and deductibles would be eliminated. Instead, employers would pay a seven percent payroll tax and employees would pay two percent, essentially converting existing premium payments to a health care payroll tax. It would remove the bureaucratic middleman of the insurance-managed care industry from the health-care equation. The General Accounting Office projects an administrative saving of 10 percent through the elimination of private insurance bills and administrative waste.

Under the PNHP proposal, everyone would be included in a single comprehensive public plan covering all medically necessary services and everyone would have access to personalized care with a local primary care physician and free choice of doctors and hospital at all times.

The 59 to 36 vote in the Senate for a patients' bill of rights* is strong evidence that grass roots organizations are beginning to make their voices heard on health care issues. The House of Representatives--where the Republican leadership plans to weaken, if not, defeat the Senate-passed version--is the next big test. President Bush has recklessly threatened to veto the legislation if the Senate bill is enacted. If the President does use his veto pen to wipe out the rights of patients, it will be a monumental political mistake and one that will leave little doubt that the powerful lobbying forces of the health insurance industry have seized the White House.