America's health insurance system is sick. The symptoms: high costs, lack of access, declining choice, increasing medical homelessness.[1] The etiology: our dependence on private health insurance. In no other industrialized nation does the majority of people rely on private health insurance to get healthcare.Private health insurance is like a sponge: It sucks up dollars but is full of holes when it comes to coverage, limiting patients' choice of doctor, hospital, and treatment. High deductibles make patients pay for preventive and primary care; so many wait until they have advanced disease. The insured as well as the uninsured are shortchanged by our system.[2]
Private insurance companies also create major problems for doctors. We are ethically obligated to our patients while insurance companies are fundamentally obligated to their shareholders: They cover the healthy and shun the sick. Each company has its own rules and drug formulary, forcing doctors to hire staff just to process bills, challenge claims denials, and obtain prior approvals.[3]
Doctors are seeking new solutions, as shown by the recent Medical Society of the State of New York membership survey: Fifty-six percent of the more than 1700 respondents favored single-payer, Medicare-for-all, national health insurance.[4]
Watch TV or read the newspaper. Everyone -- President Bush, John Edwards, Arnold Schwarzenegger -- claims a "solution," yet their solutions are bound to fail. Why? Because neither individuals, businesses, nor government can afford the hundreds of billions of additional dollars that would be paid to insurance companies. They and the billing systems they require already take $350 billion from patient care and shift it into marketing, collections, paperwork, underwriting, and inflated CEO salaries.[5]
We would take that $350 billion and put it into covering all the uninsured and eliminate deductibles and coinsurances for the underinsured. Overall, there would be no increased costs to the healthcare system.
As Chair of The Metro New York Physicians for a National Health Program, our prescription for this sick US health insurance system is some major surgery. Cut out the private insurance companies and bring in expanded, improved Medicare-for-all, automatically enrolling all US residents. Patients and doctors alike will be the winners.
That's my opinion. I'm Dr. Oliver Fein, Professor of Clinical Medicine and Public Health at the Weill Medical College of Cornell University in New York City.