National Health Insurance: The Benefits, the Risks
Ostrow, Joanne
HEALTH CARE FOR ALL National Health Insurance: The Benefits, the Risks JOANNE OSTROW During his 1968 campaign, Presidential candidate Richard Nixon operated on the premise that the...
...There Joanne Ostrow, a free lance writer, studied the British National Health Service firsthand in England last year and has conducted extensive research at Syracuse University on U.S...
...The question of insurance or public funding, they argue, does not get at the roots of the problem, which is the power of the public to control the health care system...
...The central issue remains: can Americans achieve the same system of free adequate medical care the British have learned to live with, at the same time avoiding the drawbacks...
...The Government would spend about $4 billion a year to make up the difference...
...There are no insurance qualifications...
...The NHS is available to visitors from overseas who are taken ill after they have entered Britain...
...The Federal Government acts as the insurer and administrator...
...It is an illusion, says Kidd-Hewitt, to expect a health service to erase disease by prevention and cure: health services are self-expanding...
...Programs leaving the responsibil ity to employers, reinforcing private insurance compa nies, only strengthen resistance to change...
...keeping the Government's role to a minimum while enriching the insurance companies, it is hardly a move forward...
...Priorities must be established and decisions about spending continually updated...
...a house call made between midnight and seven A.M...
...The health industry is a well-organized machine...
...Federal rather than employer insurance is advocated...
...The question is not whether there should be a national health insurance system, but what form it should take...
...How to remedy the constant lack of funds, inadequate opportunities for doctors (particularly specialists), lack of incentive for more than minimal treatment or improvement of equipment, month- and year-long waiting lists for chronic or non-urgent ailments...
...David Kidd-Hewitt, a sociology lecturer at the City of London Polytechnic, points out that the citizen is at a disadvantage...
...HEALTH CARE FOR ALL National Health Insurance: The Benefits, the Risks JOANNE OSTROW During his 1968 campaign, Presidential candidate Richard Nixon operated on the premise that the nation's system of health services was not fatally flawed and that, in fact, "Americans enjoy some of the best health care in the world...
...the process of dealing with complaints against practitioners is slow and expensive...
...Denationalization is the only answer, he feels...
...People everywhere are less willing to accept discomforts and distress that were once considered an unavoidable part of life...
...In practice, Britain has learned, one must also contend with dissatisfied doctors, overutilized services ("health consumerism"), and runaway costs...
...Neither party in Congress is ready to give the other a "victory," so reform will come slowly, compromisingly, if at all...
...there is no compulsion for patients to make use of NHS, nor is any physician forced to join...
...It should offer an example of what the United States will face in a Federal program of medical care...
...Powell believes that for the first fifteen years of socialized medicine in Britain, nationalization prevented any hospitals from being constructed...
...The running costs of the service are drawn mostly from the national exchequer, through taxes, and, to a much lesser degree, local rates...
...are modest benefits for those to be covered and endless exceptions to the list of who is eligible...
...He suggests we will find that as consumers come to perceive their needs, the demand for treatment increases...
...Nixon has more recently admitted that we face "a massive crisis" in problems of health care...
...A 1972 conference of American public health specialists brought to light the many problems confronting plans for national health care delivery in the nation...
...Any attempt at drawing comparisons must span the ideological gap between British and American ways of alysis, but notes that it nonetheless "shows overall health expenditures only six per cent higher under the comprehensive, universal equal benefits health security bill" than under the "fragmented, double-standard" bill proposed by the Administration...
...Drug manufacturers, insurance companies, the AMA, and certain individual doctors have no reason to alter their established system of financial security...
...For example, a family could be required to spend as much as $1,500 in a year under various cost-sharing features before the program pays all expenses...
...Constant reorganization of the system seems to be necessary...
...The question of centralization versus decentralization is continually debated by British authorities and onlookers...
...the pas sage of bills based on foreign models will make highquality medical services for the majority no more acces sible than at present...
...Only a re ordering of the priorities of the system, putting patient care above profits, can produce a publicly accountable health service program for all Americans...
...The insurance companies gross over $10 billion a year in health insurance premiums...
...Britain's experience with the National Health Service, operated by the central government and financed largely out of tax revenues, is closer to the Democrats' approach...
...But a recent United Nations study reveals that our public health standards have worsened: the United States ranks seventeenth in infant mortality, thirtieth in life expectancy for males, behind countries with fewer resources...
...The "new improved" title is misleading...
...The industry is presently a closed system highly efficient at extracting profit...
...health care programs...
...Nixon's proposed solution is employer insurance, or "National Health Insurance Partnership," which would require employers to "provide minimum-standard health insurance protection for their employes and dependents of employes" with employers paying at least sixty-five per cent of premium costs initially, seventy-five per cent "later...
...In the "first complete cradle-to-grave guide," National Health Service and You (1965), author Gordon Thomas sought to clarify the ground rules...
...A national health insurance system would sound like a progressive step, would give both the liberals and the Nixon Administration a feeling of accomplishment, but would in no way reorder the present two-class system of medicine...
...Hospitals are more obsolete now than they would have been without NHS, and doctor-patient relationships have worsened...
...The Democrats generally approach the problem from the opposite direction...
...Waiting lists have not been shortened...
...Medicaid would be replaced (or, more appropriately, renamed) by a government-financed Family Health Insurance Plan...
...The Kennedy plan follows these guidelines closely, providing complete hospital and medical care without deductibles and copayments...
...Hospitals, described by Ralph Nader as "sublegal systems unto themselves," resist Federal control through strong lobbying power and have no incentive to change...
...There is, therefore, a built-in bias favorable to the doctors themselves...
...earns $6...
...The earnings of an accountant in England are double those of a general practitioner...
...This is the British counterpart of the "cozy arrangement" of peer review which Herbert S. Denenberg deplores in the U.S...
...A potentially farreaching provision would create a commission to set national standards for quality health care, and to encourage group practice...
...The challenge presented by nationalizing schemes is resisted by a host of industries, according to the Enrenreichs, specifically the electronic, chemical, and insurance industries which have interests in the profitability of the present free-enterprise system...
...In The American Health Empire (1970), Barbara and John Enrenreich assess the power, profits, and politics of the complex of medical businesses...
...Present modifications to the system—Blue Cross, Blue Shield, and group medical insurance, Medicaid and Medicare—are too fragmented to relieve financial fears of illness of the majority...
...Hours of duty demanded by the government exceed those in any other field...
...Even then, if Congress passes reform bills, one wonders if the health care delivery system would be prepared to make the change...
...Judging by the pace of legislation through Congress, it may still take some time before the question is put to the test in America...
...The Nixon plan also perpetuates the present self-regulation of the medical profession, a system which has driven up costs, reduced standards, and limited availability of health services, especially to the poor...
...J. Enoch Powell, outspoken member of Parliament and former Minister of Health, answers, "Most nations will commit the same follies and it looks to me from a distance that any fashionable folly is at least as attractive to Americans as it is to Englishmen...
...Would a national health scheme be acceptable in the United States...
...This plan would provide basic health insurance protection to all low-income families with children that are not covered by employer plans...
...Medical care is free except for a forty-eight per cent charge on prescriptions, and fees for spectacles and a few other items...
...The economic pressure of doctors' fees inevitably creates interest in plans for full pre-paid medical care...
...The aim, according to the health-care plank in the 1972 Democratic platform, is to "establish a system of universal national health insurance which covers all Americans with a comprehensive set of benefits including preventive medicine, treatment for mental and emotional disorders, and complete protection against catastrophic costs, and in which the rule of free choice for both provider and consumer is protected...
...While some favor imposing a central purpose and pattern on the complex administration of NHS, others argue for more local autonomy, fearing over-standardization and uniformity...
...Tax revenues cover eighty-five per cent of operating costs for the service...
...The most profitable small business [in the United States] is the private practice of medicine," the En renreichs note, and "the most profitable big business in America is the manufacture and sale of drugs...
...Such is the state of our system of health care...
...The most telling factor of all to the success of the service," Thomas notes, "is that ninety-seven per cent of the population in England and Wales belong to it...
...Senator Edward Kennedy's proposal is characteristic...
...The general practitioner has been phased out as specialization becomes the norm...
...Even low-income families, for whom the Government pays the health premiums, would have to spend as much as $750 before complete coverage began...
...The problem of quality control is also difficult...
...A small step, in that it departs from the "fee-for-service" idea, the Nixon proposal is still far from what "national health insurance" should be...
...Britain's 10,000 general practitioners are employed by the government as "private contractors" and paid a set fee for each patient on their panels...
...free" government services breed discontent in a public with rising expectations, and, according to Powell, the people feel they get better, faster attention by paying as private patients...
...Only 600 out of a total of 23,500 G.P.s originally opted out of the system...
...social security contributions make up the rest...
...The primary aim is to provide a unified service, integrated at all levels, involving close cooperation among authorities...
...The tribunals which judge doctors' standards (set up under the NHS Act of 1946) had to be satisfactory to the professional bodies...
...Aimed at specific categories of the public, these schemes have provided no check on the rise in medical costs and doctors' fees, nor the maldistribution of services...
...system...
...Nationalized care, in principle, means improved services at lower costs...
...While strong professional participation, community interest, and volunteer activity are encouraged, the main financial control and overall planning rest with the central department...
...The program should be Federally financed and Federally administered...
...Among them: enormous costs, shortages of doctors, too highly specialized doctors, and lack of supporting personnel for the physician...
...The hospital supply and equipment industry is not far be hind...
...In June 1971, Medical World News reported that "half of Britain's medical graduates are expatriates," because of huge hospital work loads, long hours, and low pay...
Vol. 38 • April 1974 • No. 4
