Putting states in charge is a great start. Just remember it's not all broken.
Three cheers for Dr. Victor Sandler ("A vision for health care," Oct. 16) for suggesting that states take charge of health care reform. We couldn't agree more, especially in the Land of 10,000 Lakes, where we do health care better than most. Yet, while Minnesota has done better at controlling costs and maintaining low rates of uninsured persons relative to other states, the rising cost of insurance has far outpaced wage increases, and Minnesota's employers are shedding insurance for their employees, raising our percentage of uninsured and shifting more people to existing state programs. Things are not looking good for employer-based systems of health insurance and care.
Sandler adds his knowledgeable voice to a rising chorus of people challenging long-held assumptions about the superiority of the U.S. health care system. But it is important not to throw the proverbial baby out with the bathwater.
Does insurance in and of itself confer health? No, as Sandler points out, it doesn't. With rising premiums, shrinking benefits and soaring out-of-pocket costs, insurance no longer assures access to care.
Does our current payment system give incentive to providers to intervene unnecessarily? Sometimes, yes -- at times to the detriment of patient health. More is not necessarily better, but sometimes it is, and knowing what is and isn't beneficial is not always clear-cut.
Do health care providers make errors? Yes they do, with sometimes lethal consequences. We must track mistakes and do more to address them. However, many more lives are saved both in and out of hospitals by quality medical care. To even inadvertently imply that medical care doesn't make people better, or that being uninsured doesn't have consequences, dangerously misses the mark.
Approximately 45,000 people die in the United States each year due to lack of insurance, 300 in Minnesota. According to a 2011 report by the Commonwealth Fund, the country ranks last among 16 high-income nations studied on "amenable mortality" (deaths that are considered preventable by timely and effective care). The poor showing of the United States was attributable to the lack of universal coverage and the high cost of care. One-third of adults in the country report self-rationing care because of cost -- skipping tests, treatment or follow-up; not filling prescriptions or skipping doses; not seeing a doctor when they had a medical problem. Again, when it comes to financial barriers to seeking needed medical care, the United States performs far worse than its peers. One needs only to ask friends and neighbors to know this statistic is true.
Contrary to Sandler's implication, our cost problem is not that we use too much health care, though we do overtreat some conditions, especially at the end of life. In the United States, we have fewer per capita doctor visits than do our industrialized nation peers. Our soaring health care costs are attributable to higher prices, fragmented insurance and delivery systems, and to the huge amount of money we waste on administrative overhead (marketing, underwriting, claims processing and adjudication).
Yes, let's reimagine our health care system! We could start by considering a unified state system -- not one for the poor, one for the veterans, one for the seniors, one for the self-employed and one for employees of large firms, but one system, with cradle-to-grave continuous coverage, a system focused on effective health care for everyone rather than just those wealthy enough to afford it. While the debate rages nationally over the constitutionality of the individual mandate in the Affordable Care Act, many states are reimagining health care, and Vermont is leading the way toward a unified system. Minnesota could be next.
Amy Lange, a registered nurse and certified nurse-midwife, is a policy fellow on health care for Growth & Justice, a policy research and advocacy organization based in St. Paul.
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