Health as a right!

By Susan L. Adams

Californians have been dealing with the consequences of "for profit" HMOs. It's time for some significant changes.

There are 44 million uninsured Americans. This equates to the population of Canada, Norway, and Sweden combined. Thirteen percent of North Bay residents are uninsured. One-third of Americans are underinsured and can not obtain insurance because of the cost or pre-existing conditions. In spite of our amazing technology and wealth, we are not in first place for infant mortality, life expectancy, and health morbidity. In fact, Canada, which has a national health plan, has better health data than we do.

Everyone knows that prevention is less costly than acute care services. For example, it is less expensive to treat the hypertension than the stroke, it is less expensive to provide prenatal care than to treat a sick baby in an intensive care nursery, it is less expensive to provide mental health and substance abuse treatment services than to continue to fill our jails. Yet, we continue to support a program that has turned our health into a "for profit" venture without improving our health statistics.

Many dedicated health care providers are bailing out of the "industry" (it was formerly a profession) in order to find a better quality of life in other areas of work, for example, business and technology. Decisions about access to medications and/or procedures are no longer between the health care provider and the client, but now must include administrators of insurance organizations.

Individuals and businesses are paying higher premium costs for less service and access. At least 25% of people who have insurance, do not use it. Insurance companies count on increasing the number of non-users of services to increase the profit base, thus creating exclusionary clauses for pre-existing conditions.

I believe a comprehensive, not-for-profit, single payer system will return health care back to the providers and clients and the costs need not be higher. The money would be shifted. The costs of monthly premiums and copayments for medical visits and the costs of middle man administrators and clerks and the array of paperwork, would be eliminated. The system would be streamlined. There would be only one type of paperwork and coding, there would be a centralized location for billing and payments, there would only be one administrative body, health care providers and clients would have the power to determine the best course of treatment.

The Canadian Health Plan offers an example of how this could work. There have been news reports of long waits for services. However, as a health care provider, my clients have had to wait for long periods of time to have an appointment with me. There have also been times when I have ordered tests, that these tests could not be scheduled for two months. Once the patients are in my office, they sometimes wait for up to one hour because of complications that arise in other patients. So the "long waits" issue is a non-issue for comparison. In Canada, if an emergent situation arises, those clients are seen immediately. And EVERYONE has access when needed. Canada's health data are better than the U.S. and the take-home pays for Canadian's and Americans are similar because Americans pay for their health costs after taxes, and Canadians with their taxes.

The third issue after considering cost and waiting periods has been related to being able to see the provider of choice. In the Canadian system, the client has access to their provider of choice and health care issues are decided between the provider and the client, not by the administrator of the health care plan. Physicians work with the individual provinces that oversee the administration of the plan in order to determine appropriate salaries for service. Caps are placed on annual salaries, however, most physicians never reach that cap.

A fourth issue of concern has been that people would flock from far and wide to use California's comprehensive system. This could be remedied by demonstrating residency for a certain period of time. Also, federal medicare and medicaid money would still be in place for assistance with elder care and for individuals living in poverty.

The benefits would include: 1) taking the premium payments away from businesses, so they could offer higher salary compensation; 2) allowing more free market movement of individuals who no longer feel compelled to remain in jobs for fear of losing their health insurance; 3) streamlining the administrative costs and removing the "for-profit" incentives of insurance organizations; 4) having a statewide health information system to evaluate treatment and services which allow appropriate planning for future health needs of the state; 5) improving public health; and 6) improving access to health care of all Californians.

If California was a nation by itself, it would be the seventh wealthiest nation in the world. There is no reason why we can not provide a health system that is inclusive of all of our residents when other less wealthy nations are able to accomplish this. Insurance companies would argue differently, but they are trying to protect their investor's interests. Their primary focus is profit, not health.

For more information about health care reform based on a Canadian model, visit http://www.pnhp.org on the web.