The Only Option for Health Reform Is the Public Option

Published on AlterNet, by Guy T. Saperstein, August 5, 2009.

The United States has the most-expensive, least-efficient and, in many ways, most-ineffective health care system in the world …

… The World Health Organization ranks health care systems based on objective measures of medical outcomes, and the United States’ health care system ranks 37th in the world, behind Colombia and Portugal (which both spend far less on health care than the U.S.).

The United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. Although infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth. 

Not only are 47 million Americans uninsured (approximately 18.5 percent of the insurable market), 41 percent of Americans with incomes of $20,000 to $40,000 did not have health insurance for at least part of 2007, up from 28 percent in 2001; 53 percent with incomes under $20,000 lack health insurance.

There are additional costs to the haphazard U.S. health care system: More than 50 percent of the U.S. population has medical debt problems; between 1981 and 2001, medical-related bankruptcies increased an astounding 2,200 percent, and 55 percent of personal bankruptcies are now caused by illness or medical debts, despite the fact that more than 75 percent of the bankrupted individuals had health insurance at the onset of bankruptcy and illness.

Contrary to popular conceptions, the average medical bankruptcy was a 41-year-old woman with children and with some college education; more than half owned homes, and more than 80 percent were in the middle or working classes …

… The Veterans Administration health system is a socialized system, as is the military health system, as they both employ doctors and provide hospital facilities, but, ironically, none of the opponents of the public option ever mention the VA system or the military.

Rather than hundreds of payers (insurance companies) and thousands of different forms, regulations and procedures, a public option would have one payer and one set of forms and procedures.

A public health care option, like Medicare, also would offer more choice of medical providers; unlike the current private insurance system, where patients are limited to panels of providers, a public plan would permit patients go to any doctor they want, submit a national health insurance card and the government would pay — just like Medicare. It is the simplest, most efficient plan of all.

There are many ironies in the debate about the need for a public option, and one of them is that in one breath conservatives argue that the government is inherently inefficient and can’t run anything, and in the next breath argue that it would be fundamentally unfair to make private insurance companies compete against a public health care plan.

Of course, the truth is that the inefficient private system probably can’t compete effectively, but why should we protect inefficiency in health care? We don’t run police and fire services privately or the Army, Navy, Marines and Air Force, so why should private for-profit insurance companies hold a virtual monopoly on health care, especially when the evidence is overwhelming that they don’t do a very good job at it?

Congress will be in summer recess next week. This is the time your Representative and Senators need to hear loudly, clearly and repeatedly by e-mail, phone and letters that you support a robust public health care option, one modeled on Medicare. (full 3 pages long text).

(Guy T. Saperstein is a past president of the Sierra Club Foundation; previously, he was one of the National Law Journal’s 100 Most Influential Lawyers in America).

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