Money Mismanagement

Our health-care system is failing.

Millions of Americans can't get needed care, yet hospital beds are empty and hundreds of billions of dollars are being squandered on bureaucracy. There is only one way to resolve this crisis: a National Health Program (NHP) that would guarantee universal health care.

Canada has a practical and popular NHP that is federally mandated but locally administered, and well proven.

The Canadian NHP covers everyone and costs 50 percent less per capita than the U.S. system, while offering patients a free choice of doctors and hospitals. Quality of care is on par with the United States; Canada's hospitals are modern and well-equipped, its physicians well-trained.

An NHP would benefit most Americans. The only major losers would be insurance companies.

Forty-seven million Americans have no health insurance and tens of millions more have insurance that doesn't cover expensive medications and treatments. Most of the 2 million people bankrupted by illness and medical bills annually actually had coverage when they first got sick, but too often they lost it when they became too sick to work. And even those with good coverage face rising co-payments and deductibles.

Overall, Americans will spend an average of $7,129 each for health care this year, 40 percent more than any other nation. More than $2,200 per person -- a total of $662 billion -- pays for the pen and paper of the American health-care bureaucracy, according to a study published in the New England Journal of Medicine.

The money wasted on bureaucracy buys neither care nor drugs nor tests, nor comforting words. If an NHP could eliminate this bureaucracy, the money saved would allow comprehensive insurance coverage of all Americans without any increase in health spending.

Under an NHP, every American would get a plastic card entitling them to free care from any doctor, hospital or clinic of their choice -- much like Medicare. There would be no co-payments or deductibles; the NHP would pay virtually all of the bills

The transition to an NHP would be difficult for insurance companies but easy for patients, doctors, hospitals and employers. All of the money now paid as insurance premiums would go into an NHP fund as taxes. Government expenditures for Medicare and Medicaid would go into the same fund.

Private doctors would still practice in the same offices. Hospitals would stop sending bills but would otherwise change little.

For working people, an NHP would guarantee complete coverage, even during strikes and layoffs -- without the continuing pressure from employers to cut back on benefits.

And employers should also take a second look at national health insurance. U.S. employers spend 13 times as much on health benefits as their Canadian counterparts.

Polls show that most Americans favor national insurance. Even most doctors support an NHP, and more than 14,000 of them have joined with us in Physicians for a National Health Program (WWW.PNHP.ORG).

But most politicians do not favor an NHP. They argue that America is not ready for such drastic change. But Americans already pay the highest out-of-pocket costs and have the most market-oriented health system in the world. And our costs continue to rise.

Why don't more members of Congress support national health insurance, such as congressman John Conyers' national health insurance bill, HR 676?

We think it's because of the power and influence of the insurance industry; that industry takes in $100 billion more each year in health insurance premiums than it pays out in health benefits.

How long will politicians be more responsive to the financial health of the insurance industry than the physical and mental health of their constituents?

Only as long as they can get away with it.

Drs. Steffie Woolhandler and David Himmelstein are primary-care doctors in Cambridge, Mass., and teach at Harvard Medical School. They co-founded Physicians for a National Health Program, an organization of 14,000 doctors.