Many people have been pontificating about health-care reform but very few have seen the direct consequences and failings of the current system. Fewer have actually practiced medicine. Congressmen, the talk show hosts and insurance company CEOs have excellent health insurance. They never worry about affording medication.
As physicians, we would like to correct some of the widespread misinformation.
Our current system is broken and not sustainable. At least one factor contributing to the demise of the U.S. auto industry was the associated $1,500 per vehicle cost of health-care benefits. U.S. health-care expenditures per person are 44 percent to 100 percent higher than in similar countries and yet we have worse outcomes in life expectancy, infant mortality and overall quality of care.
Nearly 25 million Americans are underinsured and thus one medical illness away from bankruptcy. Lack of portability from job to job of health insurance and exclusion of Americans with pre-existing medical conditions from insurance inhibit our ability to compete on the global market. Health-care costs are increasing at a rate of more than 9 percent per year, far greater than the inflation rate of 3.8 percent or wage increases.
Most large company executives understand these issues and thus are supportive of health-care reform -- the primary exceptions are those executives from health insurance and related industries and the legislators they have lobbied with more than $1.5 million a day to be on their side.
The irony is that by implementing full coverage with a public option, we actually would save money, not by cutting existing programs, but by improving care. Billions of dollars are wasted each year in correcting medical problems that could easily have been prevented. Every day we admit patients who would not need to be admitted if they had affordable medications and outpatient preventive care.
Another huge cost is the 31 cents of every health-insurance-premium dollar that goes to profit and overhead as opposed to the 3 cents Medicare spends on administration. The expansion of our public health-care system would actually save us money in the long term through preventive care.
Most doctors recognize that the scare advertisements on TV have the problem backward. The planned health-care reform would remove bureaucrats from the exam room, not put them in between patients and their physicians. Currently, it is insurance company executives who are in the exam rooms, not the government. We rarely have a problem with government regulators intruding into clinical care in the VA, city or state hospitals where we work. We have continuous problems with private insurance companies.
Everyone in America must have access to comprehensive care that is portable and without caps, time limits or arbitrary exclusions. Ideally, we support an American single-payer model like Medicare for financing health care. Absent single-payer, a robust public health insurance option must be available for everyone to choose. Preventive and primary care must be a priority in any version of health-care reform.
As physicians and allied health-care providers, we know that none of the current health-care reform proposals under serious consideration in Congress will affect the doctor-patient relationship if passed. We took an oath to promote the well-being of our patients and to heal the sick. Give us comprehensive health-care reform, and we would finally be able to do that.
Charles van der Horst, M.D., is professor of medicine at the UNC-Chapel Hill School of Medicine. Laura Svetkey, M.D., is professor of medicine at Duke University. Eight other Chapel Hill and Durham-area physicians endorsed their article.
