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Guest Column

Nation neglects its health

By DR. MARK J. YACHT
Published January 29, 2007


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Our health care delivery system needs immediate resuscitation. No other industrialized nation, South Africa excluded, has failed to provide needed health care for their citizens. Such a failure on the part of our elected officials for so many years is unacceptable. After all, what is the United States but a large community whose first priority should be its own welfare?

More than 20,000 citizens will die this year due to lack of health coverage and barriers to quality care. Not quantified are millions that suffer with untreated hypertension, heart disease and diabetes, to name a few of our debilitating chronic conditions. Current data suggests that only 55 percent of adults get recommended health care. Add to that obesity, alcohol consumption, smoking, and preventable injury, and you have the makings of a progressively unhealthy population. Longevity, quality of life, and days lost at work fall victim to a failing health system that is touted as the best in the world - for those that can afford it. Some 47-million (and growing) people cannot, along with millions more who are underinsured.

The lack of health coverage forces many to make fundamental life choices like paying rent or visiting the pharmacy, buying school supplies for children or going to the doctor, or waiting for treatment and risking further complications from acute illness. One out of five people in this country lack health coverage and are thereby compromised for their health needs.

More than 9-million children (12 percent) in the United States are uninsured despite the State Children's Health Program, or SHiP, initiative to get our nation's kids health care; 733,000 (17 percent) of those uninsured children reside in Florida. Some 37-million Americans, 21 percent of the adult population age 19 to 65, are uninsured, including 2.8-million in Florida.

The uninsured and underinsured affect all sectors of the community. Twenty community hospitals have closed since 1995 due to insolvency, along with 21 psychiatric hospitals. Uncompensated Florida hospital care exceeded $1.7-billion in 2004. Health care costs are unstable and rising due to increasing bad debt. The community pays for this burden with skyrocketing health care bills. Fifteen cents of every dollar spent in the United States relates to health care. Yet the system remains inefficient, fragmented, and burdened with administrative costs. Sixty percent of emergency room visits could be treated in a doctor's office.

Also festering is the lack of mental health services, dental, and eye care for uninsured and underinsured citizens. This ugly growing problem remains unfixed, with hollow rhetoric instead of effective solutions.

What has been recommended? My favorite non-fix is Health Savings Accounts, or HSAs. Tell a family with a mortgage, two car payments, and kids in school that they have to put their limited dollars aside for their health care - tax free! Perhaps the total family income is $50,000 a year. If that family put all their income in such an account they might buy a few days in the ICU for one illness, or one surgery, or one heart attack. Sadly, the Florida Medical Association and American Medical Association advocated this approach. Try telling a low-wage worker to start a Health Savings Account.

What about the network of free clinics and indigent care centers? They are overwhelmed and are typically not funded to pay for needed referral services to specialists or hospitalization. Many are helped by these facilities but too many are left behind for the full range of needed health care.

State-by-state fixes result in continued inefficiency and fragmentation. Lack of health coverage is a national problem and requires a national policy.

Medicare-for-All could work and was proposed by retired U.S. Rep. Sam Gibbons. The idea ran afoul of lobbyists. The favorite cry is that government can't do anything right. Not so; government can do many things very well and can do them efficiently. Problems start when programs are seriously underfunded. Medicare-for-All is back on the table.

Insurer and government pools to cover the uninsured is not doable because there are too many uninsured.

Employer health insurance mandates worked well in Hawaii. Those underwriting health insurance have to follow consistent guidelines including sharing a risk pool with government to cover the unemployed and other uninsured. This could work. Immediately upon its implementation, efforts were made to assure no other state would adopt this policy. Corporate influence?

One payer system calls for adding another paycheck deduction and cover all employees. This takes the burden from industry and will assure at least 90 percent coverage. The others could be protected with state, federal and private pools. This is my choice.

A national health plan? Contrary to those who beat their chests that this would be socialized medicine, it could be operated through private insurers. The private practice of medicine would be protected. This is my second choice.

Keep it simple. Pharmaceuticals must also be included. Whatever the plan, if insurers aren't held to strict consistent rules of coverage, no amount of political chest-beating will give us successful universal health care for the American people.

Dr. Marc J. Yacht is the retiring director of the Pasco Health Department.

[Last modified January 28, 2007, 23:49:37]


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