Dec. 20, 2004

U.S. health care excellent for wealthy,
but it's a disaster for 45 million Americans
In an opinion piece that appeared in the StarTribune just before the last election, former U.S. Senator Rudy Boschwitz stated, as if unquestionably true, that the health care system in the U.S. is the best in the world. Undoubtedly most Americans believe this. Yet the World Health Organization ranked the U.S. health care system 37th in the World, behind most other industrialized countries. Which is true?

Oddly, both are true. For those with the wealth or the insurance to access the full range of care, the U.S. system is excellent. However, for the 45 million Americans without wealth or insurance, the U.S. system is a disaster, not much better than many Third World countries. Lack of access to basic care is one of two crises facing the U.S. health care system. And this one is unique to the U.S. among advanced industrialized countries. Though methods differ, every other advanced industrialized country provides health care to all its citizens.

The other crisis facing the health care system is not unique to the U.S. It is the explosive inflation of health care costs. While U.S. citizens pay far more for health care than anyone else in the world, rising costs are presenting a challenge to many countries.

Many different solutions are being proposed for the problem of runaway costs. One proposal is to reform malpractice laws, on the assumption that lawsuits and malpractice insurance are driving up costs. But these items account for only about 1 percent of health care costs, and so clearly cannot be a major contributor to double digit cost increases.

Another solution put forward is Health Savings Accounts (HSAs) and other forms of “consumer-driven” health care. The assumption here is that the major driver of cost increases is overutilization of health care services. Advocates of “consumer-driven” health care claim it would make people responsible for more of their health care expenses, causing them to cut back on unnecessary services, thereby reducing costs.

While it is true that overutilization contributes to costs, studies have shown that underutilization is a bigger problem. Due to lack of insurance and lack of money, people put off going to the doctor or can’t afford to fill their prescriptions. People end up with severe and costly illnesses that could have been treated more easily and more cheaply if treated earlier. “Consumer-driven” health care policies likely would dampen overutilization, but they would also exacerbate the more serious problem of underutilization.

Another solution being proposed is a single payer health care system. A single payer system would save money by steeply reducing administrative costs. In our current system of multiple payers, administrative costs represent 20-30 percent of expenditures. Medicare, a limited form of single payer, has administrative costs of 2-3 percent, one-tenth as much. It has been estimated that a single payer system would save Minnesotans about $5 billion per year in health care administrative costs. A single payer system would also provide a mechanism for covering everyone, leaving nobody uninsured.

Wellness programs, if effectively implemented, would also bring down costs. A large proportion of health care services used by state employees are for stress-related conditions. Stress-reduction, exercise, and smoking cessation programs could create a healthier workforce with lower health care costs.

The question is, How do we proceed as a union? Do we respond only to the problem of rising costs, or do we also help to address disparities in coverage? Can we address rising costs through negotiations alone, or is a broader approach required? Is a systemic solution needed for a systemic problem? Can we learn from health care systems in other countries that have universal coverage, with better health outcomes and much lower costs than the U.S.?

At the beginning of 2004, MAPE established a Health Care Task Force to try to provide information to our members that would help address these issues. The task force has been studying our current health care system, looking for solutions. We have looked at wellness programs, purchasing pools and HSAs. We have been studying systemic alternatives, including health care systems in other countries and proposals for single payer in the U.S.

The information gathered by the task force will be available on the MAPE website. This information could also be put into local newsletters, provided as handouts at local meetings, and disseminated in any way that helps get the information out and the discussion going. Ultimately, MAPE members will need to get involved in setting the direction for the union to take in addressing the crises in health care.

These issues are complex. Analyzing the economics of health care, applying the ethic of labor solidarity to the solution, and mobilizing sufficient political strength to bring the solution to reality will take a great deal of work. Hopefully the work of the Health Care Task Force will serve as an important step along the path.