NEWS FOCUS:WHEN BARACK Obama hosted a forum on healthcare reform at the White House last week, he brought together interest groups and vested interests who have been in bitter dispute with one another for decades, reports DENIS STAUNTON, from Washington
But when insurance company bosses, private hospital owners and drug company executives rose to speak, they sounded a similar tune to the doctors, patients’ advocates and healthcare unions.
“The call for reform is coming from the bottom up and from all across the spectrum – from doctors, from nurses, from patients; from unions, from businesses; from hospitals, healthcare providers, community groups,” the president said.
“It’s coming from mayors and governors and legislatures, Democrats, Republicans – all who are racing ahead of Washington to pass bold healthcare initiatives on their own. This time, there is no debate about whether all Americans should have quality, affordable healthcare – the only question is, how?”
As anyone who has watched medical TV shows like ER can testify, the United States has the most technologically advanced healthcare system with some of the best doctors in the world. Patients travel from all over the world for treatment at institutions such as New York’s Sloan-Kettering Cancer Centre and Minnesota’s Mayo Clinic and scientists at the National Institutes of Health are at the cutting edge of medical research.
The US spends twice as much per capita on healthcare than most other wealthy countries, including Ireland, and Americans use more sophisticated medical technology than anyone else.
In 2006, the US had 26.5 MRI units and 33.9 CT scans for every million people – three times the number available in Ireland per head of population.
American patients receive twice as many coronary angioplasties and are almost four times as likely to undergo dialysis as their Irish counterparts.
For all its technological sophistication and despite its massive cost, however, the American healthcare system fails to deliver the goods when it comes to keeping the country healthy.
Life expectancy is lower and child mortality is higher in the US than in most developed countries and although some Americans can access the best medical care in the world, millions of others receive no treatment at all until they become acutely ill.
“We have the worst value healthcare in the world by a long shot,” says Don McCanne, a family doctor based in San Clemente, California.
“We have runaway healthcare costs partly because of excessive use of high-tech services that are providing no benefit but as long as the providers of those services are profiting, they’ll continue to provide them and the insurers – whether public or private – just continue to pay the bills.”
For the past 30 years, McCanne has spent half his practice hours treating patients who are too poor to pay for medical care and he maintains that America’s system of healthcare funding is killing tens of thousands of patients every year.
“We have a very fragmented system of financing healthcare. We have a great multitude of private plans and then we have our public programmes – Medicaid, Medicare, the Veterans hospital system and so forth,” he says.
“There is no co-ordination between our financing and our healthcare delivery system. All these different sources of financing really don’t have control over realigning incentives that would improve the functioning and efficiency of our healthcare system.”
Most Americans have private health insurance, choosing from hundreds of healthcare plans that vary from state to state. Many are insured in group schemes through their employer, so that if a worker loses his job, his entire family can lose their health coverage.
As fewer employers offer healthcare benefits, more Americans have to buy insurance directly from providers and the cost of premiums has soared in recent years – rising by more than 10 per cent every year for the past decade, four times faster than wages.
Health coverage typically swallows up 14 per cent of an individual’s income or 17 per cent of a family’s.
Even those with insurance can face crippling medical bills as insurance companies try to avoid paying for expensive treatments, often discovering “pre-existing conditions” that the patient was unaware of, or failed to disclose, when they took out the policy.
“The cost of healthcare now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes,” Obama said last week.
“Even for folks who are weathering this economic storm, and have healthcare right now, all it takes is one stroke of bad luck – an accident or an illness, a divorce, a lost job – to become one of the nearly 46 million uninsured or the millions who have healthcare, but really can’t afford what they’ve got.”
The very poorest Americans are covered by Medicaid, a system under which the government pays their medical bills, although many have trouble finding a doctor because physicians often refuse to accept Medicaid patients due to the relatively low fees they bring.
Americans over 65 and the disabled receive free treatment under Medicare and military veterans have access to their own publicly funded network of doctors and hospitals.
The 46 million without health insurance have some protection insofar as non-profit hospitals and those who treat Medicare patients are obliged to treat anyone who comes to the emergency room with an emergency medical condition. Such patients will receive a bill when they leave – often running into tens of thousands of dollars if they have to stay overnight in hospital.
If they cannot pay, they can declare bankruptcy and the government will compensate the hospital for most of the cost.
Being uninsured in America is a risky business however, and those without health insurance are more likely to die of cancer because they are usually diagnosed only after the disease is at an advanced stage.
A 2005 study showed that patients without health insurance received 20 per cent less treatment in hospitals and were 37 per cent more likely to die of their injuries than the insured.
Obama has set aside more than $600 billion as a “down payment” on healthcare reform and he hopes to push a plan through Congress by the end of this year. At last week’s forum, all the participants agreed that any reform should ensure that every American is insured and even the insurance companies now accept that they must stop discriminating against patients on the basis of health conditions.
During last year’s election campaign, Obama proposed an overhaul that would allow anyone who is happy with their current healthcare plan to keep it but would enable everyone else to buy into the plan currently enjoyed by federal workers.
The federal plan is in fact a menu of numerous private plans and under the president’s proposal, people on low incomes would receive a federal subsidy to help with the cost of the premium.
Obama suggested during the campaign that the federal government could create its own, vast insurance pool to compete with private insurers but Republicans in Congress have been quick to shoot down that idea.
“In this effort, every voice has to be heard. Every idea must be considered. Every option must be on the table,” Obama told the forum.
One option that is firmly off the table, however, is adopting a “single-payer” healthcare system like that of most other developed countries, where the government pays most of the cost of healthcare. International studies suggest that a single-payer system would be cheaper and more efficient, as well as providing better and more equitable access to healthcare.
Americans dislike anything that smacks of “socialised medicine”, however, partly because they fear that the government could start rationing the medical care they receive. For McCanne, this fear of rationing in a single-payer system is not only irrational but ignores the reality of how the current American healthcare system actually works.
“In our free market system here in the United States, we have the worst rationing of all industrialised nations,” he says.
“Patients who have comprehensive systems worry about whether they can get an MRI when they’re 90 years old or whatever but here we ration by ability to pay. No other nation does that and people die because of that.”