Wednesday, November 05, 2008

Closing the Idealism Gap on Healthcare Reform

A new survey from the Center for Medicine in the Public Interest shows that there is an "idealism gap" among young voters when it comes to their support for government-managed health care. While a strong majority -- 83 percent of those polled -- believes that America's healthcare system is in need of reform, just 49 percent support paying for a new government-run health care program through taxes. These results weren't surprising. With tens of millions of Americans uninsured and costs through the roof, change is obviously -- and urgently -- needed. But voters are rightly skeptical of paying for a massive overhaul of our system.

Already, the U.S. government pays for around half of all healthcare expenditures. In Great Britain, where health care is socialized, 95 percent of all healthcare costs are paid for by the taxpayer.

The problem with government-run health care isn't just its price tag. Canada and other countries with "universal" care have seen increased government intervention in which types of treatments patients are allowed to access are based on cost rather than effectiveness. For patients like Linda O'Boyle of the United Kingdom, such policies can be deadly. She was diagnosed with cancer and told that medication not covered by the National Health System would increase her chances of survival. So she used her savings to pay for the medications. Upon discovering this, the NHS stopped allowing her to have chemotherapy because government laws ban patients from combining public and private care. She died in March.

Patients in the U.K. and Canada also have longer wait times to see specialists than do insured patients in the United States. Twenty one percent of Canadian hospital administrators said it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman. In the United States, fewer than one percent of hospital administrators said it would take that long.

With horror stories like this, it isn't surprising that 62 percent of the young U.S. voters polled said they would not support healthcare reforms that could increase wait times, availability of medicine, or increase government involvement in decisions affecting patients. Luckily, a few commonsense reforms would enormously expand access to affordable care within our existing system.

Right now, about five million uninsured Americans are eligible for employer-provided coverage -- but haven't taken advantage of the plans. To start addressing the accessibility problem, employers could begin enrolling their employees by default, with an opt-out option instead of an opt-in option. This would prevent new employees from going months without being enrolled. And it would cut down on confusing paperwork.

Lawmakers should also work to ensure that the 12 million Americans without health insurance who are eligible for Medicare or the State Children's Health Insurance Program sign up for those programs.

Lawmakers also could expand access to private health insurance coverage by providing tax credits for part-time and low-wage workers to buy their insurance from private companies directly. In this system, health insurance would be portable, so there would be no disruption of service when a person changes jobs. Nearly 27 million of the 45 million uninsured U.S. residents worked at least part-time in 2007.

Expensive government-run health programs that provide shoddy service should not rob young voters of the hope that health care should be available to all Americans. We can start closing that idealism gap now by reforming public health programs and increasing direct access to private insurance.


A little surgery on bureaucracy is needed

One British medical professor is thinking:

The past 50 years have produced an amazing blossoming of the biological sciences. But there is a little problem. How is a country with a healthcare system principled to provide care for all, able to afford the drugs that will cure all?

One solution is “top-up” fees. Where NHS funding is not available it has been suggested that patients be allowed to buy the drugs that they need. Mike Richards, the National Cancer Director, will report today and by exempting certain classes of patient (ie, those with conditions associated with the most pathos) recommend the principle to the country.

How do we doctors feel about this? Very uncomfortable. Just imagine the conversation: “You will be pleased to know that we can cure you. We have a marvellous new treatment.” “Great, doc.” “Oh by the way, have you got 50,000 pounds?” “Ehmm, OK . . . I’ll mortgage my house.” What about those patients who don’t have a house to mortgage? Are we saying that health is available only to the rich?

There is, however, fat in the system and it could be trimmed. The National Institute for Health and Clinical Excellence (NICE) is already too costly and unnecessary, with a role largely filled by the European Medicines Agency, which licenses treatments in the first place. We have 150 primary care trusts making 150 decisions on the same healthcare issues – including whether patients should receive high-cost drugs – at a cost of 5 billion.

Our country can have all the treatments that it needs for all the people that we treat by cutting bureaucracy. Surely it is better to slam a few fingers in desks and provide the band aids than forget the poor?


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