Health Care Brief

Thomas Britt, MD., MPH

The notion of universal health care, national health care, a single payer system, health care reform with a public option or co-operative health care dates back beyond 70 years. President Barrack Obama as a candidate and in his first eight months of 2009 has actively advocated for health care reforms. However, health reform or any political initiative(s), especially one that benefits all citizens and is financed in any way by governmental agencies, requires both executive and legislative support. Historical review of significant political changes requires strong leadership from the White House with support from both chambers of Congress. We currently have a democratic president with a commanding majority of democrats in the Senate and U.S. House of Representatives … you would think that this initiative would proceed without a lot of recrimination. Not so! Change of this magnitude will not occur, unless and until the people become active participants in the legislative process. Timing is the other paramount prerequisite to a successful legislative outcome. Legislation delayed is legislation denied. This process only begins with the vote. We the people must continuously articulate what policies and programs we want. Politicians invariably will respond to their constituents.

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care …”

This is the language that was promulgated in 1948 in Article XXV of the United Nations’ Universal Declaration of Human Rights, of which the United States was a founding member and signatory. The basic right of health care vs. a privilege is at the core of our failing health care system. Despite the UN declaration, the U.S. has chosen to adopt a market-based approach, where if you cannot afford health care, you don’t get health care. Thus America stands alone among industrialized nations as the only nation that does not assure basic medical care to all of its citizens. An argument can be made that our human rights are being violated.

National health plans were discussed during the FDR administration in the 1930s when few if any Americans were covered by health insurance. A plan was proposed as part of the developing social security initiative but was aborted for fear that its inclusion would derail social security legislation. After World War II, President Harry Truman proposed another national health plan that was defeated by vigorous opposition from organized medicine.

Consider the following time-line of political and health care events:

  • Social Security Act was drafted by the President Franklin D. Roosevelt’s committee on economic security as part of his New Deal; signed 14 August 1935
  • Blue Cross and Blue Shield emerged following the Great Depression of 1929. Masses of Americans were without employment and coverage, creating tremendous economic crises for hospitals and physicians. Blue Cross was developed for hospitals and later Blue Shield developed for physicians. Initially both were non-profit organizations using a community rating system (cost of premium based on the group’s overall claims rather than on the health of any one individual) to determine premiums. Experience rating system (individuals with higher risk are charged higher premiums) is primarily used by for-profit health insurers.
    • In 1960 the Blue Cross Commission became an independent group of the American Hospital Association (AHA) which was later severed in 1972.
    • Blue Cross and Blue Shield merged in the late 1970s.
    • In 1994 BC/BS Association abandoned its non-profit requirement of its member groups
  • Medicare and Medicaid were enacted by Congress during President Lyndon Johnson’s administration in 1965 as amendments to the Social Security Act of 1935.
    • Medicare …. Title XVIII
    • Medicaid …. Title XIX
  • Health Maintenance Organization Act of 1973 was enacted during President Richard Nixon’s administration
  • Taskforce on National Health Reform was announced by President Clinton, on the 25th of January 1993, where he also named his wife, Hillary as its head. Branded by Republicans as socialized medicine, Democratic wavering and assorted political posturing led to the disbanding of the task force on 31 May 1993.

Medical and technological advances, rising health care cost and deregulation has defined America in a unique and unenviable conundrum. We boast having the best health care system, yet simultaneously we have the worst health care delivery. More than 46 million Americans are uninsured. Conservative estimates suggest that an additional 25 million citizens are under-insured. This is a growing catastrophe for families and children. According to the Institute of Medicine and the Urban Institute, an estimated 18,000 to 22,000 adults died in 2002 and 2006 respectively due to lack of health insurance. A recent study performed by researchers from Harvard Medical School found that nearly 45,000 Americans, 17 to 64 years, die annually because of lack of health insurance. That astounding number actually represents 123 deaths per day. Americans who would be alive, if and only if, they had health insurance. Moreover the medical expenses of the uninsured and under-insured are invariably borne by those who are insured. Your rising premiums have a hidden cost to cover for the less fortunate. We spend more for health care than all other developed nations and get less, as measured by Infant Mortality (IM) and life expectancy (LE). The CDC has stated that the U.S. ranked 29th globally in IM in 2004. The gap in life expectancy, in the U.S., affluent vs. poor continues to widen to more than 4.5 years. In an article, “Health Disadvantage…” published by the American Journal of Public Health, March 2009, pp 540-548, compared American vs. European adults (ages 50-74), using common chronic diseases to measure health outcome, revealed the following:

  • American adults are less healthy than Europeans at all wealth levels
  • Death from heart disease in the U.S. was 18%, whereas 11% was reported in Europe
  • Poorest Americans experienced the greatest disadvantages compared to their European counterparts
  • Health disparities by wealth were significantly smaller in Europe than in the United States

Table 1 reveals national health care expenditures as a percentage of the Gross Domestic Product (GDP) of select nations. Table 2 and 3 depict IM and LE of the same select nations and allows the reader to compare cost to outcomes:

(Source of data derived from the Organization for Economic Co-operation and Development, 2003)

 

Table 1: Health care expenditure as a percent of GDP of select nations

Nation                                             Percentage

United Kingdom                                        7.7

Japan                                                           7.9

Canada                                                        9.9

France                                                         10.1

Germany                                                    11.1

United States                                       15.0

 

Table 2. Infant Mortality (infant deaths per 1,000 live births) of select nations

Nation                                          Infant Mortality

United Kingdom                                          5.3

Japan                                                             3.0

Canada                                                          5.4

France                                                           3.9

Germany                                                       4.2

United States                                          7.0

 

Table 3. Life expectancy in years at birth for select nations

Nation                            Male                       Female

United Kingdom                76.2                            80.7

Japan                                   78.4                            85.3

Canada                                77.2                             82.1

France                                 75.8                             82.9

Germany                             75.5                             81.3

United States                74.5                          79.9

 

If America is to become healthy, if America is to become competitive with other industrialized nations, if indeed America desires to regain its world leadership, we the people must demand real change. This is a watershed moment in our republic. Now is the time to contact your elected official(s) and advocate for a universal health care system that provides coverage for all Americans; coverage that provides support, incentives and funds for prevention and wellness. Preventing disease is cheaper than diagnosis and treatment

About the author: Thomas Britt, MD., MPH is an Adjunct Professor in the College of Health Sciences at Chicago State University. He is certified by the American College of Sports Medicine as a Health Fitness Specialist. He also serves as a Medical Ambassador of the American Cancer Society and is the Chair of the Chicago Coalition of the National Black Leadership Initiative on Cancer. October 2009. Contact: [email protected].