ANDY THOMAS: Sick System: What's Wrong With Health Care? How to Fix It?
Last week, I attended a Harvard Club luncheon in Raleigh at which Eric B. Munson spoke. Munson was the CEO of UNC Hospitals for a number of years and is responsible for many achievements there.
His talk was entitled "Why Not Universal Health Care and Why Not Now?"
He began by describing two different personal scenarios involving medical situations within his own family. His son slipped and fell at school in Charlottesville, Va., and could not be admitted to the hospital because the university had inadvertently messed up his insurance papers. It happens more than it should, according to Munson.
In the second instance, Munson's brother, Lester, needed medical care on a trip to the Czech Republic. He received it, promptly and effectively, free of charge, since any guest or tourist of the Czech Republic is automatically covered. Lester was successful in his own right, having been a well-known attorney who got tired of his clients, according to brother Eric, and is now a writer for Sports Illustrated.
These two stories represent a wide diversity in the handling of medical treatment and the costs and administration thereof.
Munson went on to describe 13 things that are wrong with the U.S. medical system, followed by a dozen ways to fix it.
(1) Medical insurance is attached to employment, leaving many people barren of any medical security.
(2) Currently, 48 million people -- two million of whom live in the United States -- do not have medical insurance.
(3) Emergency rooms are dogged with uninsured patients.
(4) Drug prices have skyrocketed for the average patient.
(5) Drug plans are inequitable. Department of Veterans Affairs patients, for example, pay much less, usually, than the typical patient.
(6) Physicians own the equipment they prescribe for their patients, such as CAT scanners, and this is a conflict of interest.
(7) Medical malpractice suits are out of control.
(8) Money paid into the system is abused and misused, like the CEO of United Health Care retiring with a payoff package of $1.7 billion.
(9) There is inadequate control of immigration.
(10) There is an epidemic of obesity and related diabetes and heart problems.
(11) There aren't enough physicians. North Carolina has 11 counties that need doctors now.
(12) The health-care economic model is dysfunctional.
(13) Professional trade associations such as AMA and AHA do not effectively support sound medical practices.
At this point, Mr. Munson related some of the reasons for our inadequate health picture. Back in 1945, Harry Truman declared that it was every U.S. citizen's right to have adequate medical coverage, but the AMA fought it. Blue Cross/Blue Shield emerged as a solution, but it was tied to employment. While Canada and other countries introduced federal health programs, the cost of U.S. medical systems rose inordinately.
Finally, in 1965, Lyndon Johnson signed a bill enacting Medicare, apparently providing medical assistance to all. But this was aimed at aged and dependent folks, not the working man or woman. Employers were asked to foot more and more of the medical expenses of their workers.
The cost of health care will always be increasing because of the lack of nurses, aging, TV drug promotions, obesity, and the nationalizing of stories about keeping people alive, no matter what.
Here are Munson's remedies to our health-care crisis, which he calls the "American Health Plan":
(1) Everyone should be eligible for most medical options provided by Medicare.
(2) The cost of this program would come from a 23 percent flat tax, which would replace the IRS and its taxes.
(3) The plan would be funded by the federal government and administered by states.
(4) Primary care physicians would be paid a standard salary, while specialists would earn their pay based on the services and specialties they provide.
(5) Medical students would sign contracts to provide services where needed.
(6) No one would be refused medical treatment based on social, economic or any other reason.
(7) Duplication of medical facilities would be eliminated.
(8) The price of pharmaceuticals would be regulated.
(9) Medical students, interns and residents would be funded federally and administered locally, by states -- a practice similar to that of Canada, Norway and other countries.
(10) Non-economic damages involving medical lawsuits would be capped at $500,000.
(11) Foreigners would receive medical care as long as they became U.S. citizens within one year.
(12) Nonsubscribers to the plan would be on their own.
Supporters probably won't include trade associations and drug companies, but businesses should be in favor, since their costs would be much improved, according to Mr. Munson. He thinks if this or some other solution doesn't take effect soon, the number of uninsured, now 48 million, will undoubtedly grow.
While I thoroughly respect Mr. Munson for his stature and many achievements, I believe his proposal for correcting our medical crisis is unrealistic. His idea for a national health plan is valid, but we will never be ready for primary-care doctors earning a straight salary while their counterpart specialists earn much more. Nor will a flat tax ever come to pass.
I think California's new plan for better medical coverage is more viable. I may follow up this piece with the state health plans of Massachusetts and Pennsylvania, both of which have proposed a state health plan for all patients.
Andy Thomas lives in Pinehurst. Contact him at firstname.lastname@example.org
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