By Alice Faryna, MD

Despite the acrimonious debate, there is actually consensus on both sides of the political aisle -- our current health care system is seriously flawed, dysfunctional and requires major change.

As Congress prepares for a final reconciliation, we are bombarded with messages containing language designed to either persuade or frighten us.

In a country as diverse as ours, we need to find common ground for deeply held beliefs and values. Values held by most Americans are quality, affordable, choice and American. Surveys consistently find that over two thirds of Americans favor health care access for all Americans, even if it means a major government role. The words government health care had a negative response, yet the same people wanted a choice of private and public plans.

Recent messages from politicians say they favor a uniquely American solution. Unfortunately, we already have a unique system. Our system costs twice as much as those of most other wealthy nations and fails to cover almost 50 million of us. Since World War II, our health system has relied on employer-based coverage purchased from private for-profit health insurers.

Our uniquely American employer-based private health insurance solution is unraveling. Any employer-based system is particularly vulnerable to economic downturns. Since the current recession began, tens of millions of Americans have lost their jobs and therefore their coverage. Even before the recession, the percentage of employers offering health benefits was falling. Only the expansion of public insurance like Medicaid and SCHIP prevented an even worse epidemic of lost coverage.

Health care costs have continued to soar at twice the rate of the Gross Domestic Product. Employers have responded by asking employees to pay a greater portion of insurance premiums and larger co-pays and deductibles.

Over a million American families fall into bankruptcy each year partly due to large health care bills. Even those with employer-based insurance are at risk since over 70 percent had insurance at the start of the bankrupting illness. Consumer Reports National Research Center released a January 2009 survey of over 2,000 Americans who regularly take medications. It shows that 22 percent have delayed a doctor visit, 18 percent put off a recommended procedure, 17 percent declined a test, 16 percent delayed filling a prescription and another 16 percent stopped taking a medication due to costs.

Other wealthy countries cover all of their citizens for about half of what we spend. Some are entirely public programs. Others like Germany and Switzerland allow private companies to offer insurance products, but they do not allow them to operate for profit. In these countries, universal coverage creates a large stable risk pool which combined with government run insurance or strictly regulated not-for-profit private insurers results in lower costs, better health outcomes and no bankruptcy from medical debt. These countries have covered everyone with high quality care at a more affordable price.

The House proposal retains many of our uniquely American flaws: preserving a for-profit system and relying on private insurance competition to bring down premiums. The proposal does contain new regulations that require insurers to take all applicants regardless of gender or health status, and guarantees the renewal of existing policies.

However, the much debated public option, originally conceived to ensure real competition, is at risk. In order to avoid a government takeover of health care, the proposal dictates the creation of a new bureaucracy -- the Health Insurance Exchange -- to help bewildered consumers choose an insurance plan. Our tax dollars will be spent on subsidies for low wage earners who cannot afford insurance but will be required to purchase private or public insurance.

Wouldn’t it be simpler and more efficient to allow people to buy into Medicare and set the premium at a level that covers costs? This “uniquely American” solution serves our seniors well. Medicare has proven to be a durable and reliable insurance program that has controlled health care costs better than private insurance exchanges. We know Medicare works. Medicare, unlike private insurance, allows you to choose any doctor or use any hospital. However, the insurance industry asserts that competing with Medicare is not a choice they will allow; calling it unfair and not on a level playing field.

We must continue to ask tough questions. For example, in a year where private insurance companies are posting record profits, why is the taxpayer being asked to subsidize them in order to cover the uninsured? Why isn’t a public option like Medicare a choice for everyone? Real reform must cover everyone and controls costs.
Dr. Faryna is a retired internist and an organizer for the Ohio chapter of Physicians for a National Health Program.
Copyright (C) 2009 by the Ohio Forum. 9/09