HEALTH FOR LIFE

Cures for an Ailing System

With health care emerging as a major issue in the 2008 presidential race, NEWSWEEK asked seven Harvard experts to identify specific problems that ought to be addressed, and the steps that should be taken to solve them.

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Under Strain: A family seeks help for chronic ailments at a facility for low-income people
 

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Ensure That Every American Has Health Insurance
Everyone in America should have health insurance that covers at least a basic level of care. This would give them access to medical services and ensure that health-care providers are paid. Improving access to care this way would actually slow the growth in health-care spending because people who become seriously ill—who have a heart attack, for example—wind up receiving costly medical care, subsidized by society, even if they are uninsured. Preventing that heart attack by removing barriers to health care not only improves health, it saves money.

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A strong economy will not get us to universal care; the robust economic growth and tight labor markets of the late 1990s did not substantially reduce the number of uninsured. And we cannot expect significant numbers of the uninsured to pay for insurance on their own—just over half of the uninsured today have family incomes below $30,000, and premiums for self-purchased family policies are typically $10,000 or more. Many of the uninsured will need highly subsidized insurance. On the other hand, three out of 10 uninsured have incomes (above the median household income of $48,200 in 2006) that put them in the middle class. Most of these people might buy private coverage if they could find affordable policies.

The presidential candidates differ in the levels of detail about what they would do to reduce the number of uninsured, but they all assume that employer-sponsored health insurance will continue to cover a majority of Americans (currently 60 percent). The problem with this basic strategy is that globalization is forcing American companies to become more competitive in what they pay for labor. Employers increasingly resist paying more than a defined amount for health care; most cannot continue to pay health costs that have doubled in the last decade. In just the last seven years, the fraction of employers sponsoring health insurance has declined from 69 percent to 61 percent, and those that continue to provide it are asking employees to pay an increasing share of medical costs. We need to create a new financing structure that includes employers, before a majority pull out of paying for health insurance altogether.

A strategy worth examining is that of the Netherlands. Two years ago the Dutch created a new system that uses a combination of premiums and taxes to finance health insurance for everyone. People have a choice of 33 health plans, each of which shares a common set of health services. Each adult pays a modest annual premium (about $1,500) that depends on which health plans he or she chooses. Everyone also pays an income-related premium tax, so low-income people are subsidized and all children are covered. The income-related tax is reimbursed by workers' employers. Some of the tax revenues are used to adjust payments to health plans that enroll people likely to have higher medical expenses—thereby reimbursing plans for higher-cost indi-viduals and ensuring that they receive quality medical care.
Katherine Swartz, PH.D.Professor of Health Economics and Policy at Harvard School of Public Health

Eliminate Racial Disparities
As a practicing physician, I know firsthand that health care can work wonders for those who need it. Equal opportunities for good health are among the greatest benefits society can provide. Many research studies have found, however, that African-Americans, Latinos and American Indians often do not receive these benefits, for treatments ranging from primary care of diabetes to high-tech heart surgery.

For African-Americans, current disparities in health have deep roots in slavery and segregation. Even as overt discrimination in health care has been largely extinguished, the embers of inequality smolder and reignite. In Chicago, for example, death rates from breast cancer were nearly identical for white and African-American women in 1996. By 2003 these death rates fell 35 percent for white women but actually rose 12 percent for African-American women.

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Member Comments

  • Posted By: Home412AD @ 10/26/2009 11:54:09 PM

    People get the health care they deserve. Some folk don't appear to grasp the economic and financial foundations of the medicine business. That is perplexing, because they are very simple and easy to understand. Health care is extortion -- "Your money or your life." A doctor is a criminal, a member of an organized crime syndicate no government can control. Lawyers may reduce their fees to attract customers, but any doctor who reduces her fees is condemned by all her medical peers as an incompetent, until she has no customers. The very last thing the medicine business can tolerate is competition. They must remain a Mafia, in which every member is sworn to loyalty and the code of silence.

    To repeat, no government can control the medicine mafia. We will all need a doctor someday, politicians and senior officials as much as anyone else. No one -- no one -- in any government can breath a word against doctors, or make any attempt to control their rapacious demands for more and more money for less and less work. Someday they will need a doctor, and the mafia never forgets, and never forgives.

    The juvenile daydream that we can ever reduce the cost of the medicine mafia is a fairytale fantasy. The medicine business rules, and they will never surrender power. "Your money or your life," forever. Do you want out of this trap? Don't go to a doctor. Chose to die instead. That's your only escape route.

  • Posted By: Mrs.Cleaver @ 04/25/2009 7:27:46 PM

    Dude, go back to your attempts to legalize marijuana. You are obviously stoned!

  • Posted By: melpol @ 02/08/2009 3:13:47 PM

    The big secret is out----it takes only 12 months to train a bright high school graduate to be a family doctor. The average wage of a doctor or any worker in the healthcare industry should not be more than twenty dollars an hour. This is a fair wage for a person who should spend only 12 months in training.

    The average person imagines that a doctor is some sort of wizard that has magical powers to heal, but this is far from the truth. A doctor was once a student who didn't know the difference between a kitchen knife and a medical scalpel. Expensive and unnecessary years of medical school and a ten dollar stethoscope have created the modern version of the WITCH DOCTOR or MEDICINE MAN. The only magic that these doctors possess is the trick of emptying your bank account. It is not called magic but: "street wisdom".

    The whole medical industry including doctors should be tossed to the free market system and be relieved of all government supervision. This idea will cause the biggest backlash since the suggestion that the earth was round instead of flat. The idea that the stethoscope is a magic wand available to only the chosen few is so implanted in the average persons head that it will take a constant bombardment of truth to remove it. The overpaid healthcare industry will spend billions of dollars to prevent deregulation. But they will lose to the fact that healthcare can be affordable.

    The outcome of a deregulated healthcare industry will be that the consumer will be king. Word of mouth is the best messenger of top performance. The bright open heart surgeon that learned the trade in twelve months will have many customers when former patients speak highly of the doctor's skill. The cream rises to the top and so will the best doctors. Those that haven't the aptitude will leave the industry when they find that their waiting rooms remain empty.

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