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  Real Health Care Reform - Universal Single-Payer
Organizations like Physicians for a National Health Program want Americans to have the same system in place in all other Western countries and elsewhere, including Venezuela, South Korea, Japan, Cuba, Brazil, Saudi Arabia, Costa Rica, Singapore, Taiwan, and Thailand. But not in America - the only industrialized country without it despite spending more than double per capita than the other 30 OECD countries and delivering less for it. In a September 2007 report to Congress, the Congressional Research Service (CRS) compared 2004 US health care spending with other OECD countries: -- America then averaged $6,102 per person, well over double the average $2,560 for OECD countries;
-- US health care spending was 15.3% of the economy compared to 8.9% on average for OECD countries; for Canada it was 9.9%; Germany - 10.6%; Great Britain - 8.1%; France - 10.5%; and Japan 8.0%;
-- "US prices for medical care commodities and services are significantly higher than in other countries (delivering comparable care) and serve as a key determinant of higher overall spending;" high insurance and drug costs are the most significant factors;
-- life expectancy in America is lower than in other OECD countries;
-- the US ranks 22nd on life expectancy at birth; post-65, it's 11th for men and 13th for women;
-- America has the third highest infant mortality rate after Turkey and Mexico;
-- heart disease, cancer, and respiratory diseases are the top OECD country causes of death; America ranks 17th for heart disease "despite (performing) substantially more invasive heart procedures than all the other (OECD) countries;"
-- quality of US health care isn't superior overall; nor do Americans "have substantially better access to health care resources, even putting aside the issue of the uninsured;" and
-- because of the cost, many Americans delay or forego treatment. WHO ranks America 37th overall, behind Saudi Arabia, United Arab Emirates, Iceland, Malta, Colombia, Cyprus, Morocco and Costa Rica and about equal to Slovenia and Cuba. In other measures, it has the US 24th on life expectancy, 72nd on level of health, 32nd in distribution of care, 54 - 55th in financial contribution fairness, 15th in overall goal attainment, and first in per capita amount spent. If Obamacare is adopted, it will drop America lower in world rankings by making its dysfunctional system worse. In a 2007 Commonwealth Fund study comparing Australia, Canada, Germany, New Zealand, the UK and US, America ranks last as in its earlier studies on access, patient safety, efficiency, chronic care management, and equity. Most notable is its absence of universal coverage. Overall, the US ranks poorly on its ability to promote healthy lives through affordable, high quality care. Its for-profit system prevents it. National Coalition on Health Care (NCHC) Data Founded in 1990, NCHC is the "largest and most broadly representative alliance working to improve America's health care." Its membership includes Common Cause, Consumers Union, AARP, Children's Defense Fund, several labor unions, numerous medical groups, including the American Cancer Society, American Heart Association, and American Academy of Family Physicians, League of Women Voters, and National Council of La Raza. Below are data it reports on US health care coverage, costs and quality. (1) Health insurance coverage: -- most Americans have employer-provided insurance; costs are shared, and as industrial America became more service-based, employment no longer assures coverage, and when it does it's often woefully inadequate;
-- in 2007, about 46 million Americans were uninsured, and nearly 90 million (about one-third of the below-aged 65 population) lacked coverage during some portion of the year;
-- working adults with no insurance topped 20% in 2006; the same year (before today's economic crisis) 1.3 million full-time workers lost coverage; and
-- employment-based coverage was 62% in 2007; rising insurance costs are largely to blame; from 1999 - 2007, premiums rose 120%, over four times the rate of wage growth; -- annual costs are rising at twice the rate of inflation;
-- in 2007, it was about $2.4 trillion or $7900 per capita;
-- estimated 2017 spending is projected to be $4.3 trillion or 20% of GDP;
-- for 2008, the average cost of health insurance for a family of four was about $12,700; it topped $4700 for single coverage but is much higher for older singles and those with a history of poor health;
-- employee contributions to company-provided coverage rose 120% since 2000; out-of-pocket costs for deductibles and co-payments rose 115%;
-- medical expenses are the leading cause of personal bankruptcies;
-- in normal economic times, about 1.5 million families lose their homes annually because of unaffordable medical costs; and
-- America spends six times more per capita on administrative costs than other industrialized nations. -- despite spending more than twice per capita of other developed countries, America ranks low on many quality measures, including life expectancy, infant mortality, and ability to receive needed care;
-- only 54.9% get the care they need; over 100 million insured Americans get sub-standard treatment, especially for high-cost procedures, surgeries, hospitalizations, and other extended care; and
-- overall America's health care system fails to deliver quality care to growing millions; affordability is the major factor. Calling itself the advocacy organization for "high-quality, affordable health care for all Americans," Families USA says US Census Bureau data "indicate that some 45.7 million Americans lacked health coverage in 2007." On its web site, it says nearly 3.7 million more lost coverage since January 1, 2008. Those without it now number nearly 50 million, and their ranks are rising exponentially each month. A May 2009 Health Affairs.org-published Todd Gilmer - Richard Kronick study estimated the following: -- 44,230 Americans currently lose health coverage each week;
-- 191,670 each month;
-- 2.3 million each year; and
-- by yearend 2010, 6.9 million more Americans will be without it unless new policy measures halt it. Single-Payer Legislation in Congress On January 26, 2009, HR 676: United States National Health Care Act or the Expanded and Improved Medicare for All Act was introduced in the House "To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes." It was referred to the House Energy and Commerce, Ways and Means, and Natural Resources Committees. No further action was taken. The bill proposes the following: -- establishes the United States National Health Care (USNHC) Program to provide all residents in America and US territories with free health coverage - including all necessary care, primary and preventive care, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care;
-- only public and non-profit institutions may participate;
-- patients may freely choose their providers;
-- prohibits private health insurance duplicative of this act; insurers may sell non-medically necessary benefits like non-essential cosmetic surgery;
-- establishes a USNHC Trust Fund to finance the program from existing government revenues, a personal income tax increase on the top 5% of earners, a Tobin-type tax on stock and bond transactions, and progressive payroll and self-employment income taxation;
-- creates a confidential electronic patient record system;
-- establishes a National Board of Universal Quality and Access to advise on quality, access, and affordability; and
-- integrates the Indian Health Service and Department of Veterans Affairs programs into the new one. The legislation is largely similar to the House bill to provide all lawful US residents with health care services. It establishes a State-Based American Health Security Program, an American Health Security Standards (developmental and administrative) Board, and an American Health Security Quality Council to review and evaluate guidelines, quality standards, performance measures, medical review criteria, and develop minimum competence criteria. It also creates the Office of Primary Care and Prevention Research at NIH within the Director's office and amends the Internal Revenue Code to fund the program.
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