We deserve U.S. health care

We deserve U.S. health care
Most citizens back national insurance. A bill in Congress would provide this.
By Adam Gilden Tsai

Imagine if Congress passed a bill requiring national public discussions regarding the state of health care in America. Then imagine that these discussions actually happened across our country, and that across the country there was actually a consensus that we need national health insurance to ensure that everyone has access to care. Finally, imagine that when the final report, to be presented to the President and Congress, is drafted, the report makes no mention of this consensus.

There is no need to imagine these things because they have actually happened. The same act that created the Medicare prescription-drug plan mandated the Citizens' Health Care Working Group (www.citizenshealthcare.gov). The group, which included people from medical and public-health backgrounds, held meetings in cities across the country this year. The questions asked (and voted on) at each meeting were the same, and fell into several categories: what health-care services are important; how health care should be delivered; how best to pay for care; and what trade-offs Americans are willing to make to ensure access to quality affordable health care.

I attended the Philadelphia meeting in April, and there was a range of opinions on some of the topics discussed. Some people voiced a need for better coverage of services such as eye and dental care; others wanted more comprehensive end-of-life care; and still others felt we needed a more rigorous system of health education. There also were differences of opinion on financing issues. For example, some people believe that only the most basic level of benefits should be covered and that everything else should be paid for out-of-pocket, while others felt that anything deemed effective by providers and patients should be covered.

One thing, however, on which there was strong consensus at the Philadelphia meeting, and across the country, was that we need a national health-care system to ensure that everyone has access to care. In fact, when given a choice of 10 reform options, participants in most cities clearly favored a national health program by a ratio of at least 3-1. At meetings where participants were asked to rank the 10 options, national health insurance was ranked first 16 of 19 times (Billings, Mont.; Denver; Des Moines, Iowa; Detroit; Eugene, Ore.; Indianapolis; Jackson, Miss.; Kansas City, Mo.; Memphis, Tenn.; Miami; New York; Philadelphia; Phoenix; Providence, R.I.; Sacramento, Calif.; and Seattle). At two meetings, participants were not polled and options were not ranked.

Despite the clear public mandate, the Citizens' Health Care Working Group's report makes no mention of the vast support for a national health program. Instead, the group's official recommendations include only generic suggestions such as promoting "efforts to improve quality of care and efficiency" and finding a way to protect "against very high health costs."

From my experience, most supporters of a national health program favor a single-payer system, which retains the private delivery of health care by physicians and hospitals, but organizes payment under a single public agency. A 2003 study in the New England Journal of Medicine found that a single-payer national health-insurance program would save enough on administrative costs - more than $300 billion per year - to cover all of the uninsured and provide full benefits for everyone else.

Public opinion polls show that Americans favor a system of tax-financed health insurance by a 2-1 ratio, as opposed to our current system linking coverage to employment. A May 2006 Keystone poll found that 66 percent of Pennsylvanians favor the U.S. government guaranteeing health insurance to its citizens even if it means raising taxes. The main obstacle to universal health care is the health-insurance industry, which has made a mint covering healthy people who don't use very much care while avoiding the sick patients who need coverage the most.

If our politicians are listening, they'll realize we don't need Wall Street-controlled health-insurance plans to provide us with health care. We need a streamlined system that can provide quality affordable health care for all. U.S. Rep. John Conyers of Michigan has introduced such a bill, the U.S. National Health Insurance Act, also known as House Resolution 676. We should all be pressuring our senators and representatives to support it.
Adam Gilden Tsai, MD, of Philadelphia, is a member of Physicians for a National Health Program (www.pnhp.org), a not-for-profit group that advocates for a tax-funded, privately delivered system of national health insurance.