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Examining healthcare

July 05, 2007

Re "The plague or the cure?" Opinion, July 1

Ronald Brownstein's overview and analysis of insurance as the healthcare delivery mechanism is missing a few key elements. He neglects the overriding reason that a single-payer system is largely absent from the dialogue on healthcare reform: Politicians are unwilling to dismiss an industry that helps finance their increasingly expensive election campaigns.

One need look no further than Medicare to see the cost advantage that a single-payer system has over private insurance. Private insurers' frictional costs -- those costs not for policyholders' claims -- are exponentially greater than Medicare's frictional costs. Insurance as the healthcare delivery mechanism is inherently inefficient.

Asking insurance companies to govern the quality and quantity of healthcare services received by consumers makes no sense. Asking the same insurance industry that caused the problems endemic to our healthcare system to solve those problems now seems rather foolish.


Woodland Hills


Health insurance companies are not the root cause of the high costs, spotty coverage and relatively poor quality of the U.S. healthcare system. To get at the root cause of the poor performance, one has to dig down to the source of the decisions that drive cost and quality -- the physician-patient interaction. Put simply, when a physician paid on a fee-for-service basis treats a patient who is insured for the cost of care, there are no constraints on cost and no incentives to promote prevention.

What is the solution? Make Medicare mandatory and universal? Ask bureaucrats in Washington to devise methods to alter the basic decisions made between physicians and patients? No, the cure to high costs, poor quality and the underuse of prevention requires that the physician become financially at risk for the health of a defined population, rationing out the "limited" resources provided by society for healthcare to produce the best health at the lowest cost.

Under such a system, prevention moves to the forefront and high-tech, high-cost services are limited to those clinical situations in which the costs are balanced off by significant clinical benefit.


Health Economist

USC School of Pharmacy

Los Angeles


Brownstein summarizes the argument of those who favor a single-payer system as "that it saves money and improves care," while failing to note that these claims are supported by the facts. Most Western countries with single-payer systems achieve better healthcare results, including important measures such as longer life expectancies and lower infant and maternal mortality rates, while spending significantly less on healthcare.

On the other hand, he summarizes the opponents' argument as that it "discourages innovation and causes long waits through shortages and bureaucratic delays," while failing to point out that this is unsupported by the facts.

He says that a system without private insurance is, and should be, beyond the realm of political possibility, which would lead one to suppose that the arguments against a single-payer system were valid. With the government spending $2,000 per person on healthcare -- more than the governments in the single-payer systems of Europe, Canada and Japan spend -- while failing to achieve similar healthcare outcomes and not covering all citizens, it is time for the U.S. to adopt a single-payer healthcare system.


Aliso Viejo

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