We Can't Afford to Not Have a National Health Insurance Plan

By Dr. Kenneth Brummel-Smith

Michael Moore’s most recent documentary, Sicko, has increased the heat on the discussion of health care in America. It is high time Americans and their representatives took a hard look at the state of health care we have. If I did a physical on our health care system, I’d have to say it is not doing too well. And the prognosis is grim.

The United States has some of the poorest measures of health in the world. In most measures, we are among the worst in the world. Among the developed countries, we trail those with national health systems in almost every way health care is measured. Compared to European countries we have the highest infant mortality. The average in the US is worse than the infant death rate among the poorest of Canada! Mothers don’t do well here either — we have a maternal death rate that is between two and 3 times that of the Europeans. At the other end of the age spectrum, we have the shortest life expectancy when compared to all European countries, Australia, and Japan. And even for those lucky enough to have insurance, 28% report having difficulty getting needed care. Of course, we all know they have to wait in long lines to get care in those European countries, right? Wrong — the percent of people in the other countries report having to wait at much lower rates than us — only about 15% report difficulty getting care.

But we all know they control health care spending in those countries by rationing health care, right? Wrong again! Take a look at high cost procedures and compare how we do: bone marrow transplants — we’re just average, Australia, France and Italy have higher rates; hospital stays — everyone is higher than us (anybody in your family forced out of the hospital because insurance isn’t going to pay for more days?); Denmark, Italy and Japan have more MRI units per capita than we do; everyone of the European countries, Canada, and Australia have more nurses per patient than we do; and the mentally ill get more services in the other countries than citizens of the US get here. These facts have been published in respectable medical journals and are all available for anyone who wants to check them on the Physicians for a National Health Program website (

The fact that really angers me is that in spite of these woeful statistics, we end up paying more than anybody else in the world for health care! Health care costs per person are as much as double other developed countries. The average cost of health care in America is now over $7000 per year. Most European countries spend $3000 — $4000 per year. In fact, the portion of annual cost of health care in America that is paid by public funds (Medicare, Medicaid, Veterans, government employees) is over half of our costs and exceeds most other countries total expense. Where does all this money go?

Profit. To those who say we can’t let the “government run health care” and we should let the market solve our problem I say, “Wake up. The market IS the problem.” For-profit health care has been shown in numerous studies to be excessively costly, prone to abuse and fraud, and poorer quality. For-profit HMO patients get fewer preventive services. For-profit HMO patients with stroke get less rehabilitation and end up in nursing homes more than fee-for-service patients. For-profit hospitals have a 2% higher death rate and yet cost 19% more. For-profit hospitals hire fewer nurses and having fewer nurses has been shown to lead to poorer outcomes. We also use make use of unnecessary treatments and surgeries. As many as 1/3 of all hospital admissions are preventable and 1/5 of many surgeries are unnecessary.

But wouldn’t a government-run insurance plan be wasteful and expensive? Medicare spends 3% on overhead. For-profit health plans spend 14% to 21%. In fact, the insurance companies call what they spend on actual medical care for patients a “medical loss.” All European countries have overhead margins in 3% to 7% range, meaning 93% to 97% of their money is spent on health care.

A national health insurance plan is the only workable solution to our dire situation. A single payer would allow us to control health care costs by having one system that measures quality. In countries with national health insurance you never even see a bill! A physician’s office never has to check to see if your insurance covers what you need, in fact, the office usually has only one person working on bills because there is only one form to use.

With almost 50 million people uninsured, and tens of millions more underinsured, the reality is that those of us with insurance pay for the others anyway. As the President said, patients can get emergency care in our system. Hospitals negotiate higher rates to pay for the uninsured with the insurance companies. But emergency care is very expensive and the costs would be significantly reduced if everyone was insured.

Two governmental agencies, the General Accounting Office and the Congressional Budget Office, have estimated that the cost savings in having a universally insured population would pay for the uninsured. Malpractice costs would decrease because one never need sue for future medical costs. Companies would become more competitive on the global market because they wouldn’t have to worry about health care for their employees. Americans would be healthier because they would get preventive services plus all needed health care. Maybe we’d even catch up to the Europeans and Canada in health measures!

There would be losers though — for-profit HMOs and hospitals would have to covert to non-profit status, pharmaceuticals would have to start charging fair prices because they’d have to negotiate with the national health insurance plan, television stations would probably have to stop advertising so many questionable drugs, and some very rich medical specialists would have to stop doing unnecessary surgeries. Do you see the tears running down my face?

Kenneth Brummel-Smith, MD, Charlotte Edwards Maguire Professor and Chair, Department of Geriatrics, FSU College of Medicine, former medical director of Providence ElderPlace in Portland.

He can be reached at