http://www.freep.com/article/20090727/BLOG2506/90727072/1068/opinion/The-health-care-debateBy JAMES C. MITCHINER
James Mitchiner, M.D., is an Ann Arbor emergency physician and the former president of the Washtenaw County Medical Society
"In the health care debate, the one question we should be asking is: What is the marginal value of having private health insurance?
After all, if the purpose of health insurance is to mitigate the financial consequences of catastrophic illness or injury, the current level of medical bankruptcy shows that having such “insurance” is, for many Americans, anything but. Recent research from Harvard University and Ohio University showed that 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the illness that pushed them or their families into bankruptcy court. Yet we continue to trust private insurers. Policymakers and federal legislators seem to have blind faith in their ability to solve the problems of American health care.
...Aside from costs, for-profit insurance companies will tell you that they facilitate high-quality health care and offer more choices than a government plan would offer. Really? There is no evidence of which I’m aware that for-profit insurers consistently provide better quality of care than their nonprofit private and public plan counterparts.
The argument that for-profits preserve choice of medical providers is also invalid, given that the “choices” are made for you through the insurers’ selective contracting with provider networks that include a limited number of physicians and hospitals. In addition, those who feel that they can go to any doctor of their choice without incurring additional costs should remember that over 90% of metropolitan areas are served by only one or two insurers.
But there is a viable alternative. Single-payer health insurance is simply a way to finance universal health care. By replacing the 1,200 private insurance companies – each having its own set of regulations, provider networks, prescription drug formulary, pre-authorization forms, 1-800 number and Web site – into a single insurance entity, such a single-payer system would reap the benefits of economies of scale, reduce administrative waste, mitigate bureaucratic duplication, sever the link between health insurance and employment, reduce health care disparities, and at last provide creditable coverage for the millions who lack it now.
...President Obama’s goals for health reform are to expand access to high quality affordable care, control costs and preserve choice. Single-payer health insurance is the only plan that will simultaneously and synergistically accomplish all three goals, and without breaking the bank. We should stop pretending that the private insurance industry can do it better."