Commonwealth study serves health care campaign

Debate on overhauling the U.S. health care system has centered on cost, administrative waste, and profiteering. Such concerns are hardly misplaced, what with 2006 health care costs rising to 16 percent of GDP, or $7,000 per capita.

In 2004, when U.S. costs came to 15.3 percent of GDP, those in France, Britain, Germany, Sweden and Canada hovered between 8.7 and 10.9 percent. Princeton economist Uwe Reinhardt recently attributed 21 percent of excess health care spending to overspending on “health administration and insurance.”

Private health insurance companies apply 20 percent of all revenues to profit, administration and marketing. Hospitals and clinics dealing with insurance bureaucracies have to add another 12 percent in costs, bringing the total health care overhead bill to 32 percent, according to Physicians for a National Health Program. Analyst Steffie Woolhandler reports private for-profit health institutions charge 19 percent more than their not-for-profit counterparts.

Health care, however, relates to human well-being, dignity and survival. The case for radical change in U.S. health care gains strength when its supporters enter the dimension of human reality often downplayed in the news blur of financial piracy.

In a report based on international comparisons released Nov. 13, the Commonwealth Fund enlarges the discussion by detailing dire effects of U.S.-style health care on people’s ability to cope with illness.

The report surveys the care of adults afflicted with chronic illnesses living in Australia, New Zealand, the Netherlands, France, Germany, Britain, Canada and the United States. Interviewers engaged with 750 to 2,600 persons in each country diagnosed with hypertension, heart disease, diabetes, arthritis, lung diseases, cancer or depression.

U.S. patients led in reporting wasted time and delays in obtaining care and complaining of provider errors, duplication and poor coordination. They were exceeded only by
French patients in viewing care recommendations as valueless.

During the survey year, 29 percent of U.S. respondents had no insurance. Of these, 82 percent “did not fill a prescription, get recommended care, or see a doctor when sick because of costs.” U.S. chronically-ill patients were tops in having to pay out-of- pocket costs, with 41 percent of them giving up $1,000 or more.

Diminished access due to cost affected 54 percent of U.S. patients and 23 percent of those from other countries; 34 percent and 21 percent respectively complained of poorly coordinated care; 34 and 22 percent, of medical, laboratory or medication errors.

Survey authors attribute good showings by Great Britain and Holland in coordination, trust in providers and access to care to strong primary care systems involving family doctors. The U.S. sample led in complaints of irregular sources of care, particularly lack of personal physicians. Yet U.S. medical graduates entering family practice training programs dropped 50 percent between 1997 and 2005, according to the New England Journal of Medicine. Pediatric and internal medicine educators noted similar trends favoring specialty careers.

Analysts see medical graduates’ high debt loads as encouraging high-paying lines of work. Public support for U.S. medical education is nil.

Writing earlier this year in “Health Affairs,” Ellen Nolte and C. Martin McKee document preventable human suffering. They examined recent falling mortality rates in 19 industrialized countries — specifically deaths “amenable to health care” among older adults. In 18 countries, the decline averaged 16 percent; in the United States, 4 percent. They suggest 101,000 deaths would not have occurred if the United States had matched improvements demonstrated by the three top performing countries.

These reports touch upon actual manifestations of inequalities and unfairness. Words to educate and mobilize for health care change are crucial. One recalls Martin Luther King’s judgment, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” But battle-cries and expression of ideals alone are insufficient, especially as progressive forces, encouraged by the November election results, renew the fight for single-payer, universal health care.

They work with two sets of realities. The money story needs retelling and explanation so that profiteering and insurance companies are excluded. And awareness of the human realities of care, illness, and death assures both that the urgency of the health care crisis is not overlooked and also that, as consciousness of shared experience deepens, unity in struggle advances.