Walter Bradley is the Chairman of the Department of Neurology at the school of Medicine at the University of Miami. He has written a long piece (available here) on how he thinks we should solve the uninsurance problem. Here’s the short version:
Introduction
We all know that the United States health care system is in trouble. The US spends over $2 trillion a year on health care, almost 17% of the GDP. By comparison, Switzerland, Germany and Canada spend about 10% of their GDP on health care, while United Kingdom spends less than 8%. Despite this, the 2005 Commonwealth Fund International Health Policy Survey of sicker adults from six countries, Australia, Canada, Germany, New Zealand, the United Kingdom and the US reported that "(t)he United States often stands out with high medical errors and inefficient care and has the worst performance for access/cost barriers and financial burdens." Moreover, the US lags well behind many other countries in indices of quality of care. In 2005 the US ranked 42nd among the world’s nations in infant mortality, with 6.50 infant deaths per 1,000 live births, behind such nations as Singapore (2.29), Sweden (2.77), France (4.26), Canada (4.75) and United Kingdom (5.16), and was 29th among developed countries in maternal mortality. In 2004, 46 million people (15.7% of the US population, about one-fifth of them children) were without any form of health insurance. Many of these have been without health care for years, though others are between jobs that provide health care coverage. In addition another 50 million people in the US have inadequate health care coverage and would be bankrupted by a serious illness.
Most people without health insurance do not have primary health care and only obtain medical care when they suffer an illness that is sufficiently severe as to take them to the Emergency Department of a public hospital. The stroke or heart attack costs the public hospital and the local taxpayers much more than would the control of blood pressure by a primary care doctor.
Health insurance premiums are skyrocketing. In 2004 the annual premium of an employment-based group plan for a family of four averaged $9,950 and workers are contributing an ever-increasing amount to these premiums. The percentage of people with employment-based health insurance in 2004 was 61 percent and is likely to fall further in the coming years as employers strive to reduce health insurance overheads.
The current system of health care for the medically indigent is fragmented, expensive and inefficient. The exact cost of health care for the uninsured in the US is difficult to assess because it is fragmented between Medicaid, the public hospitals, physicians and the insured public. In fact, the US may well be spending more per capita on health care for those without health insurance through these various sources than it does for those with insurance.
I propose a comprehensive cost-effective system of medical care for those without health insurance, the National Health Service for the Uninsured (NHSU). The creation of the NHSU would not immediately address all the ills of the US health care system, but it would provide health care for those without medical insurance, improve the overall health of US citizens, and introduce cost-saving systems that might eventually help the overall US health care system.
An integrated system of health care for the medically indigent in the United States, the National Health Service for the Uninsured.
This proposal for the provision of improved health care to those without medical insurance envisions no change in the current system of fee-for-service medical care, which would continue to provide for the 80% of the population with private health insurance or Medicare. As now, these patients would continue seeing their own doctors and the health insurance programs would reimburse the doctors, hospitals, laboratories, etc. for the medical services they provide.
The National Health Service for the Uninsured (NHSU) would replace the current fragmented "non-system" for the 16% of the US population that is currently without health insurance. The NHSU would be a comprehensive, cost-effective federal program. It would be an integrated health care system for the uninsured based on a new primary care physician network, and the staff and facilities of public hospitals that contracted to join the program. The NHSU would provide medical services from the family practitioner to the specialist, from ambulatory care and home health services to the hospital and nursing home services. It would provide laboratory services, medications and durable medical equipment, and the services of allied health professionals for all covered patients. When fully operational, the NHSU might approach revenue-neutrality for the US as a whole if it were funded centrally by redirection of monies currently going to provide inefficient and costly indigent care through federal, state and local funding. It has been suggested that the incremental annual cost to the federal government of providing health care for the medically uninsured to the level of that provided by insurance-based and government-based coverage would be $34-69 billion annually. However, the cost to Society of shorter lives and poorer productivity of 50 million people without health insurance has been estimated to be $65-130 billion per annum.
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