A call for universal health care

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.)

Comments

  1. paolo

    Hi J Hoffa,

    I have some experience in the eyeglass industry. You’re absolutely right: as a rule, eyeglasses are ridiculously over-priced. You mentioned $350 for a pair. Actually, with more expensive lenses, $500 per pair is not unusual. You can get good quality frames on the wholesale side for under $30 (or cheapies for under $5). These are typically marked up to $100 to $300, or more. Single-vision lenses typically cost $2-$3 per pair, and then require a simple edging process to fit the frame. These lenses typically retail for $70 to $100 per pair.

    Fact is, if someone just wants a basic, no-frills set of glasses using their insurance, there is no way they should have to pay anything out of pocket. But third-party payors typically calculate their reimbursements based on something called the “usual and customary” RETAIL prices. Of course, when eye doctors report these prices to insurance companies, as they are required to do, they (as you would expect) jack up the price as high as they can get away with. How do they get away with it? Because the insurance company doesn’t really care, so long as patients keep paying the premiums.

    Of course, if someone wants to pay a few hundred bucks out of their own pockets for some designer frame and fancy lenses, I say more power to them. But the third-party payor system just naturally leads to over-pricing, as the system is currently set up.

  2. Hugh

    For the past twelve years I have been covered by Medicare and also by supplementary insurance from my former employer administered by UHC.

    During this time Medicare has provided more consistent, predictable and prompt service than has UHC.

    If I had a choice between a program provided by Medicare and one by UHC, I would unhesitatingly choose Medicare.

    Based on my experience I would strongly support a single payer system administered by Medicare.

  3. Greg

    The largest cost of medical care are those who want everything, including the newest treatments. Would government ran health care provide the newest and best, for everyone? Or would it be system that the public gets one level, government employees get a better system and the politicians get the best (Germany)?

    Also we have a problem in that many people will not listen to their doctors. In Europe the doctors can refuse treatment, even force assisted suicide on such patients. We have those in the US (ie Dr Peter Singer of Princeton) who feel that those who have chronic illness should be terminated. Switzerland is now allowing the termination of those with extreme mental illness (expensive to treat), Holland terminates extremely sick infants. Would this be our furture?

  4. Lenore

    Jarrod Lombardo, you forgot one thing about raising that $1-$2 gas tax. You’re right, it’ll hurt the poor and middle working class. So where will that extra money come from when they buy gas at the pump? They’ll have to go to the boss and ask for a raise so they can get to work. The boss then has to raise the price of his product or service. So it’s coming right back out of the consumer’s pocket. Guys, there is no free lunch!

  5. charlie

    I have to respectfully disagree with the doctor. The price of fuel and how many miles driven in the UK can not be compare to the USA. The UK has a public transportation system that reaches just about every corner. This can not be said of the USA. I would love to walk to the corner to catch a train or bus to work but its not avaialble. Thats why you and I can not compare the UK & USA. Please stop with the “lets tax gas to get there”