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Sunday, January 29, 2006

Junk Medicaid ... and Replace it With Universal Health Insurance

Alex Gerber, M.D., clinical professor of surgery emeritus at the University of Southern California, adds his voice to those calling for universal health insurance, the only viable replacement he sees for a Medicaid program in danger of "meltdown":

Junk Medicaid, by Alex Gerber, Commentary Washington Times: Medicaid, the government health-care plan for low-income people, has been targeted ... as a prime source for savings in a bloated federal budget. ... A lowering of Medicaid costs by $6.9 billion is proposed over the next five years, which will decrease benefits and raise out-of-pocket expenses for the 47 million Americans... The nonpartisan Congressional Budget Office predicts an appreciable number of Medicaid recipients ... will join the ranks of the medically uninsured. The adverse morbidity and mortality statistics of the uninsured are well documented...

Few are happy with Medicaid today. Patients are unhappy with eligibility red tape and the declining number of doctors willing to treat them. Doctors are unhappy with the mountains of paper work and unrealistically low fees. Most hospitals are unhappy because Medicaid's reimbursement doesn't cover the cost of patient care.... But unhappiest of all are government agencies struggling to control costs... Meanwhile, the public hospitals are alive but not well. ... After 40 years, we must reluctantly conclude Medicaid has been a well-intentioned program that has fallen short of expectations....

The great majority of Americans ... believe health care should be a fundamental right and a public rather than a private good. A single standard of health care, regardless of ability to pay... What, then, should replace Medicaid? ...

Our outmoded, employer-based, privately financed, multipayer health-care system ... is an anachronism in the 21st century. The world's richest and most powerful nation is unique in not sponsoring government-controlled Universal Health Insurance (UHI) other industrialized nations have enjoyed for decades. Unlike Medicaid, Medicare -- UHI for the elderly -- has been a resounding success. Medicare, though also targeted by Congress for budget cuts by increasing patient-out-of pocket payments, is indeed widely recognized as the most important advance of the last century in our health-care socioeconomics. Medicare for our entire population is probably the most likely answer to Medicaid's "meltdown."

I have previously advocated on these pages a change to the Canadian, single-payer health-care plan funded by national health insurance. ... Canada's medical results equal ours at a huge savings. Perhaps the superiority of Canada's health-care system was best expressed by a Harris Interactive Poll among the leading industrial societies that evaluated patient satisfaction with their system: Canada ranked first and the U.S. last. ... Significantly, The new Conservative government in Canada did not advocate major changes in the UHI program.

Of interest is a comparison of prescription drug prices in the U.S. and Canada. ... The attempt to constrain skyrocketing drug prices was hamstrung ... by President Bush's insistence there be no price negotiations with pharmaceutical companies. Thus, our Medicare population, ... has been denied the advantage of bulk-buying economies of scale. Imagine the uproar if Hertz and Avis were, by law, denied discounted prices on autos they purchased in huge lots. ...

The future for national health insurance looks bleak. The issue has never been on President Bush's agenda. ... A major reform of our wasteful health-care system will help put the brakes on an inexorably rising national debt that will eventually fall on our children and grandchildren. It would be well to recall an admonition from George Washington's 1796 Farewell address: "by vigorous exertion to discharge the debt" -- not ungenerously throwing upon posterity the burden which we ourselves ought to bear.

    Posted by on Sunday, January 29, 2006 at 02:06 AM in Economics, Health Care | Permalink  TrackBack (0)  Comments (30)

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