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By STEVEN N. ROUS
The Providence Journal
Two of the most pressing problems facing America are health care, with more than 46 million people uninsured, and our voracious consumption of automobile fuel. I would like to suggest a way to address both problems. I empathize deeply with the uninsured; I am a doctor.
The only sensible thing to do is to eliminate the health-maintenance organizations (HMOs), preferred-provider organizations (PPOs) and all of the various for-profit health-care plans that gobble up enormous amounts of money in the form of overhead, including extravagant executive salaries and dividends for shareholders, and go to a single-payer plan.
A Medicare for all, if you will.
Patients would have their choice of physicians as patients on Medicare do at this time, and as most patients using HMOs or PPOs do not have. Why would this be less costly than the present alphabet-soup insurance plans? Because the overhead for Medicare — as run by our government — is 1 percent to 2 percent.
You read that correctly. The overhead for Medicare is less than 2 percent. The overhead for various private insurance plans (HMOs, etc.) is 15 percent to 25 percent.
The big question, of course, is how to finance a program of Medicare for all. I do not believe it can be done all at once because I do not believe there is, at this time, the political will to do so. The way to bring about a Medicare for all is to cover various groups on a bit-by-bit basis until the plan is universal.
Our voracious fuel consumption could offer a gigantic start toward financing health coverage for many of our uninsured citizens, while also reducing the dollars we send to oil-producing countries that do not have a lot of love for the United States.
Automobile fuel is being consumed in this country at the rate of well over 9 million barrels a day, according to U.S. government figures.
Much of this is consumed by absurdly oversized, gasoline-wasting vehicles. Since our government has been reluctant to use its authority to conserve fuel by imposing strict mileage-per-gallon requirements on all automobiles, SUVs and pick-up trucks, I propose placing an additional federal tax on gasoline sales at the pump of $1 to $2 a gallon and to earmark all this revenue ($140 billion to $280 billion) for health care.
A heavy gasoline tax is routine in virtually all of Western Europe, where one will only rarely find large sedans, pick-up trucks or SUVs. (This past summer I spent a month in England working as a volunteer physician at our largest Air Force hospital, and noted that gasoline there costs, at the current rate of exchange, $7.40 a gallon.)
Such a tax would significantly cut automobile gasoline consumption because people would drive less or buy cars that are more fuel-efficient.
It is estimated that, in 2006, Medicare Part A (hospitalization) and Part B (physician’s fees, labs, etc.) together cost about $340 billion to cover all of our citizens currently under the program (about 43 million people).
Think about what we could do with the revenues generated from the proposed gasoline tax, estimated to be, with a 10 percent reduction in gasoline use due to the increased cost of gas, at $125 billion to $250 billion a year.
If $340 billion was the total Medicare bill in 2006 to cover those 65 and over, even half that amount could be used to lower the current Medicare age limit from 65 to 60 or even 55 — at the very least for Part A, but quite possibly for Part B as well.
Or we could cover outpatient health care for all U.S. children ages 1 to 12, and perhaps for needed hospitalization as well. (I do not propose using the gasoline money to cover the newborn intensive-care nursery because this can be prohibitively expensive.)
If we are to have such a universal system, there will have to be many changes in the way health care is provided and funded. Consider the current physician-reimbursement methods used by the military, the Department of Veterans Affairs health-care system and many, if not most, university medical faculties.
In these organizations, preventive care is emphasized and physicians are salaried.
In a system of universal health care, there may well be physicians who would continue to earn $300,000 or $400,000 — or more — a year by catering to a small segment of the population choosing to remain outside the Medicare system. That is certainly all right.
The government would also have to provide malpractice coverage for physicians working within the Medicare system, exactly as the government now does for physicians working within the military and the VA systems.
(Stephen N. Rous, M.D., is a clinical professor of surgery (urology) at Brown University. For more stories visit scrippsnews.com.)