This is the first of two articles about 10 important myths in the Great American Health Care Debate.
There are sweet-sounding myths in the American odyssey to a viable health care system, siren songs of simple solutions that lure us onto the rocks of irrelevant debate. It’s time for us all to stop believing them and stop fighting over them. Then, these myths would no longer divide and distract us and draw our collective attention away from the real issues and work necessary for real progress and change.
The first American health care myth is that we cannot afford health insurance for all. Every other modern, western industrialized country has figured out how to care for all of their residents for half of what we spend per capita to care for fewer than all of ours. A better system would cover everyone and cost less. Our failure to insure all Americans is a failure of will, not of wealth.
The second great American health care myth is that other countries that insure all of their people have socialist, government-run health care systems. The truth is the health care systems of most European countries have primarily private hospitals and physicians and primarily private health insurance. Many workers get their health insurance through private employers. Only Great Britain has a truly nationalized health system which employs the physicians, runs the hospitals and provides the insurance. Health insurance for all does not have to mean a government-operated health system for all or government health insurance for all. So let’s stop allowing the boogeyman myth of “socialized medicine” to scare us out of looking at good models elsewhere for insuring every resident at an affordable cost.
The third great myth is another about health care systems elsewhere: Copying one of those systems will mean less choice for American patients. In fact, the opposite is true, because every other universal insurance system in the world offers more choice than ours. The American system often puts limits on our choices of physicians and hospitals, tests that can be ordered or types of pills taken. It limits whether patients are insured based on work and ability to pay.
Our system limits the likelihood some infants will survive to adulthood with an infant mortality rate higher than some Third World countries. It limits the lives of some patients by depriving them of health insurance. It limits our economic freedom with high out-of-pocket medical expenses and by being the only one of the G-20 nations that allows residents to be bankrupted by medical bills. None of the other systems does any of these things to its patients. Where they do limit choice, the limits apply to most or all residents regardless of ability to pay. America’s system not only offers the least amount of choice to patients, but it also is the least democratic health care system among western industrialized democracies. Choose to stop being bamboozled by the myth about choice.
The fourth great myth is that protecting physicians from frivolous lawsuits will substantially reduce health care costs. I love this myth, but numerous studies have shown that limits on suits and settlements have little long-term effect on physician behavior and malpractice premiums. The Congressional Budget Office recently estimated that aggressive malpractice reforms might cut health care spending by three-tenths of 1 percent.
The idea that if some people would just smarten up and stop using emergency departments unnecessarily our collective health care costs would be reduced substantially is just another happy myth, today’s fifth. The idea gets lots of hype, and hope, but the bang for this buck is limited. For example, a 2008 study estimated that a 25 percent reduction in use of the ER by Medicaid patients would cut Medicaid costs by only 2 percent, in part because it takes money to provide patients with alternatives to ER care. Close America’s ERs tomorrow and our costs will keep going up.
Those are five myths that should be dead in the Great American Health Care Debate. In two weeks, join me to kill five more.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.