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by Donald L. Bartlett and James
B. Steele
Reviewed by Alissa Pines
The authors of Critical Condition have a very clear diagnosis for
what is ailing America’s dysfunctional health care system – the
health care industry has evolved into big business, to the detriment
people’s lives and livelihoods.
Many of us have experienced the nightmare of dealing with our own
or our family’s health care needs and come away frustrated with
the treatment we receive from hospitals and insurance companies. Think
of the child who is in and out of the hospital over the course of
six months while he undergoing lifesaving treatment for a rare form
of cancer. What happens to his family when they receive a hospital
bill for over $200,000—a fee representing four times what they
might expect to earn in a year? Bartlett and Steele provide
us with numerous examples of families holding garage sales and mortgaging
their homes to pay these bills. Some of them are forced to take
out high interest credit cards, burdening them with debt for the rest
of their lives.
These are the realities that our nation’s uninsured and underinsured
face everyday. And their numbers are growing. More than
44 million Americans are uninsured and the number of underinsured
is even greater. Most of them are those who make too much to
qualify for Medicaid and too little to opt into more insurance plans
that offer more extensive coverage. These are the working poor
and the middle class whose low-wage jobs often provide inadequate
or no health insurance. Bartlett and Steele point out that we
cannot simply blame corporations for underinsuring their workers,
we must also look to the industry where doctors and drug makers are
charging exorbitant rates for treatments and products which employers
and the insurance companies with whom they negotiate rates simply
cannot afford.
The bottom line is this: health care is a business. Critical
Condition provides a myriad of examples of the corporate culture that
is taking over what was once a largely not-for profit industry. What
does this mean for the average consumer? This means that in
order to save costs, hospitals have cut down on ER beds and supplies
for certain treatments. It means that a hospital visit might
be shorter than you or your doctor think necessary because your insurance
will only cover your visit for the duration that their consultants
have recommended. It means that nursing now has one of the highest
job turnover rates of any occupation due to job-related stress. This
also means that your call to settle an insurance billing question
will likely be routed to a call center in India. Finally, it
means that health care executives are getting caught in the Enron-type
corporate corruption scandals (think HealthSouth).
The difference between health care and other industries, however,
is that people’s lives are at stake. Calling a health
care provider and being told that there are no available appointments
is not like calling your bank and being routed through six switchboards. The
wait for a sick person could mean the difference between life and
death. So what do we do, for example, about seniors getting
on buses and going to Canada to fill their prescriptions? I am not
optimistic that the Republicans in Washington are going to begin imposing
price ceilings on pharmaceutical products any time soon. So
what we need to begin doing is figuring our ways around the market—innovative
ways to cut the costs of providing insurance so more funds are available
to provide essential medical treatment.
The approach to addressing the health care disaster that Bartlett
and Steele favor is the implementation of universal, single-payer
health care. Essentially, this means that there is one agency
that is charged with collecting all medical fees and paying all claims
on behalf of the vast number of public and private insurance entities. Doing
so would eliminate nearly one third of overall
costs borne by these companies. These administrative duties
are eating up a huge portion of employee premiums and employer payments. Streamlining
this process would eliminate wasted manpower for the insurer and hassle
for the insured. Less overhead would also avail funds that could
be used for better quality care and access to necessary prescription
drugs. Most importantly, these funds could go towards
providing health coverage to every American, eliminating the socio-economic
and racial disparities that exist between those who have insurance
and those who do not.
It is alarming to me that in the world’s richest nation where
the federal government spends $1.7 trillion (over 15% of GDP), we
continue to have a health care system that is out of reach to so many
Americans. It is time for government to step in and begin to cut the
waste by trimming administrative overhead. Critical Condition
only strengthens the case for fundamental reform in the health care
system.
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