Universal Health Care:
What the Doctor Ordered?

By Deb Nerud, B.S., M.L.S., NREMT
ASH News Daily Reporter

Although a complex issue, it is time to consider universal health care seriously as an alternative to the current system in the United States. “It’s time for ASH members to educate themselves,” stated Ken Zuckerman, M.D., who moderated the Plenary Policy Forum Sunday afternoon and encouraged everyone to join in the ASH Grassroots Network.

Dr. Zuckerman gave examples of some problems with the current healthcare system in the U.S.:

• Approximately $1.5 trillion dollars are spent for health care each year
• More than 40 million people have no insurance coverage at any time
• Nearly 75 million people have no coverage for part of each year
• Services are rationed by an individual’s financial status
• About 22-25% of the total cost of insurance goes toward insurer profit or administrative costs.

Eric Book, M.D., Blue Shield of California, gave insight to some of the advantages of a universal health care system. Lack of coverage is becoming a more recognized problem in the U.S. and a growing number of individuals join the group of uninsured annually. “Insurance rates have gone up double digits in the last three years,” stated Dr. Book. “By 2006, the annual premium for employer-sponsored coverage is expected to be $14,545 — double the 2001 rate.”

Universal coverage is essential if the goal is to eliminate the cost shift from people without insurance to those who have it, and to spread costs and risks more evenly. Blue Shield became involved in a proposal for California as they believe their future depends on it. “We have a stake in diverting meltdown,” said Dr. Book.

Dr. Book also stated that his company’s goal is to insure every Californian and to ensure that no one is denied for any reason, including pre-existing conditions. Other advantages of the universal system include the new revenue the system would generate, elimination of insurer incentives, and retention of the contributions of existing employer-based plans. “It would cost $7.8 billion in California to have universal health care. Businesses now offering coverage would save $900 million and individuals with current coverage would save $810 million or 5%.” The government would pay for its share by increasing sales tax 1% and a slight increase in personal income tax.

Former Oregon Governor John Kitzhaber, M.D., gave insight into the implementation of the health care policy in his state. “Our goal is to provide the greatest benefit for the greatest number of people,” he said. “We currently give some people coverage for everything and other people coverage for nothing. It costs far more to leave a large segment of the population without coverage than it would to establish an explicit policy of universal coverage. People who cannot afford to pay for insurance coverage gravitate to the emergency department and the cost is shifted back to the public.”

Dr. Kitzhaber said the focus should be on the benefits and setting priorities. In Oregon, the priorities were developed by bringing together clinical effectiveness and research with physician experts. Examples from the high priority list in Oregon include acute fatal conditions, chronic fatal conditions and maternity care, with futile care and conditions with no effect on health status considered low priorities. The list is revised every two years to match the budget cycle.

“This prioritization shows that it is technically and politically possible to manage health care,” concluded Dr. Kitzhaber. “Meetings like this help educate and are an enormous step to help bring about reform.”