Mary Gabb (firstname.lastname@example.org)
With President-elect Obama’s proposed plan to reform the US healthcare system, this will be the closest the US has gotten to universal health coverage. We provide a snapshot of the Obama healthcare plan and highlight some of the criticisms it has received from health economists.
The Obama plan mandates affordable, accessible health coverage for every person and attempts to control healthcare spending. To achieve the former, the Obama plan eliminates the concept of “pre-existing conditions.” Every American can purchase health insurance regardless of current medical conditions or previous medical history, by choosing from any of the following options:
The Obama plan will seek to reduce costs by:
Several health economists have criticised the Obama plan. Among their criticisms, from an economics point of view:
From the healthcare point of view, the Obama plan may create more problems than it solves:
The US Congress will determine how much of his plan is implemented; only time will tell if it is successful.
With healthcare in the US consuming about 16% of GNP, or around 2 trillion dollars a year, and still leaving an estimated 47 million people uninsured, is it time for Americans to adopt a universal, government-run health system?
Dr Walter Tsou (pictured right) certainly thinks so. A tireless advocate for such a system, the former president of the American Public Health Association and health commissioner for the City of Philadelphia, Dr Tsou is convinced that single-payer national health insurance would not only be more equitable, it would also be more efficient.
In an interview with HOC , Tsou pointed out that calls for the healthcare system he espouses are gathering momentum as the expense and waste of the existing system make it increasingly untenable. He cites the growing influence of Physicians for a National Health Program (PNHP), a non-profit research and education organisation of 15,000 physicians, medical students and health professionals who support a single payer.
Unlike the Canadian system, he says, which is both federally and provincially funded, he would favour a centralised US federal approach that would absorb the current Medicare and Medicaid programmes; but like the Canadian health system, which has been in place for almost 40 years, it would cover everyone.
PNHP, in which Walter Tsou is a board member, believes that because the existing US patchwork of private insurance bureaucracies and paperwork consume more than 30% of every healthcare dollar, streamlining payment through a single non-profit payer would save some $350 billion a year.
What would happen to existing private insurers if single payer came into force? Says Dr Tsou: “They could become fiscal intermediaries… process claims; or cover some services that might not come under the broad umbrella of a national health plan.”
And what about the physicians? Well, he says, primary care doctors would earn about the same as they do now; specialists would probably be paid less. However, he notes, practice overheads would be dramatically reduced, and the current cumbersome business of patient co-pays and deductibles would be eliminated.
Finally, Dr Tsou emphasises that under a national plan, prevention would be a priority, and smart cards with physician access would be universal. “It’s a win-win for society,” he says.