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William C. Altreuter
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Thursday, August 09, 2007

Joe Conason nails it: "While health care is a highly complex matter, the reason that other countries can afford to cover all of their citizens—while spending a smaller portion of their national income than we do—is fairly simple. As a study by Physicians for National Health Program revealed, more than 30 percent of health care costs in the United States represent corporate profit and useless paperwork. Roughly 20 percent goes to insurance companies alone, which burn enormous amounts of money finding ways to deny care to their policyholders. Multiply those costs for profit and “management” by the numerous insurance companies with which every hospital and doctor must cope simultaneously, and the result is an ongoing nightmare of corporate bureaucracy and paper-shuffling waste."

Doctors make a lot of money. Interestingly, most people do not believe that they make too much money-- they do work hard, and they do possess specialized knowledge. The thing that a lot of doctors point to when the fact of their relative affluence is pointed out is that their training is extremely expensive, and they are obliged to start their professional lives under a lot of debt. (The fact that this is true of most college-educated people is glossed over. Doctors have more debt, sure, but also are compensated at a rate that comfortably compensates for the discrepancy.) A lot of docs will also point out that they pay big dough for malpractice insurance, but that is a bogus argument-- they never talk about what percentage of their overhead goes to malpractice insurance premiums, and in any event, that's really just overhead.

We could solve all of these problems quite easily by socializing the works, including the cost of medical education. I'd be prepared to move medical malpractice litigation into a system that works like worker's compensation, and it seems fair enough to me that the cost of training our medical professionals should be borne by society as a whole. It actually already is pretty heavily subsidized. I suppose the health insurance industry would be pretty unhappy about it, but what have they ever done for us? I don't propose abolishing private health insurance-- if people want to purchase additional coverage over a particular minimum, why not?-- but basic health care should be a social welfare benefit for everyone, the way it is for veterans, old people, poor people, and members of Congress. Would that be a two-tier system? Sure, just like we have now, only with universal coverage, instead of a two tier system in which over half the population has essentially no access to health care at all.

Because I value my professional independence, I am not proposing that doctors become governmental employees. I merely advocate for a single-payer system, with mandatory participation by all physicians for the first ten years of their post-training practice. After that, if they want to opt out, or have a side practice run on a private insurance fee basis, g-dspeed. Naturally participation by any hospital that receives any sort of governmental funding would be obligatory. I suppose you might assume from this that I hate doctors, but I don't, really. I hate that they surrendered their profession to the insurance industry, but it is not as though they simply signed it over. It was more like the camel's nose, a little at a time, until there wasn't any room in the tent any more, and although there are a lot of doctors who are good businessmen, not many doctors went into the healing arts with that as their goal. Nobody really likes the present system, except the insurance industry that profits from it. Doctors carry more overhead than they want, and patients can't get the care they should be receiving. Employers have to pay premiums, which eats into their bottom line.

The system we have now has wrecked the country's industrial base. Our glamor profession gets the blame, but so-called "tort reform" is looking at the wrong end of the problem. It is debatable as to whether high insurance rates are caused by litigation-- the insurance industry seems to do pretty well as a whole. Occasionally a carrier fails, but I recall a conversation I had with a clever underwriter in Zürich a few years back. "If I can't figure out a way to write it so that we can both stay in business," he said, "Shame on both of us." The fact is that what drives the cost of liability insurance up is that the cost of health care in the US is out of control-- and the way that the risk is spread is colossally inefficient. Single payer eliminates this, and spreads the risk over the entire society. Maybe it's Red Communism, but socialized medicine has given Europe a huge competitive advantage, and it's past time we stopped pretending that the existing system works.

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