Warren Philip Stark is an artist and retired entrepreneur living in La Costa, California. He BS/BCE degrees from Rensselaer Polytechnic Institute BS/BCE; MBA from Harvard Business School. As US Naval officer, he served in the Pacific and Europe during WWII and the Korean War. He spent five years in mid-1960s with the Defense Advanced Research Projects Agency where he originated and managed a $100 million multinational research and development program aimed at defeating counterinsurgency and terrorism in Thailand, Vietnam, and Lebanon. He went on to build houses; own an electrical wholesale company; work for GRC International in charge of corporate acquisition. He also founded, organized and managed a software division specializing in occupational health information systems, His art is in public and private collections around the USA. Visit his work at www.WarrenStark.com
The United States is the only major industrialized nation in the world that does not provide universal healthcare for all its citizens. We are satisfied to allow people to die because they cannot afford health insurance. We are satisfied to allow people to become bankrupt because they cannot afford large medical bills. Yet we believe we are a society of high moral character. We also believe we have the best healthcare system in the world. This may be true for those wealthy enough to be able to afford whatever healthcare services are needed. On the average, although our healthcare system is far more expensive than in any other country, it is no better than the healthcare provided by the other industrialized nations.
In this year of 2009, the US Congress is attempting to make improvements to our healthcare system. The attempt is largely unsuccessful because the private health insurers and the pharmaceutical companies do not want any laws passed that will negatively impact their bottom line and also because the Republicans do not want the Democrats to score any legislative or executive victories. The private insurers have undue influence over congressmen through their lobbying and through their contributions to re-election campaigns.
Some watered‑down legislation may well pass that will protect the drug manufacturers, which will provide more customers to the private insurers, that will exclude any real competition in the business and that will provide some benefits to the general public, such as the elimination of pre-existing conditions to obtain insurance and the protection against cancellation of policies due to illness.
Many people believe, I among them, that a single payer system is needed to cost‑effectively provide universal coverage. Medicare is one such system. Medicare exists and it works. It is said that people want choice. The choice they really want is the choice to select their own doctors and medical facilities and the choice for them and their doctors to make their own medical decisions. Medicare provides these choices. The cost of providing Medicare has increased over the years. The real problem to be solved in providing affordable health care is how to contain the costs. The fee for service model encourages doctors to perform more services and order more tests than may be necessary in order to increase revenue. Doctors may also do this as a defensive measure to protect themselves against malpractice suits. I personally do not know many doctors who are getting rich from their medical practice. I have heard many complaints to the contrary. It would be great if we could compensate medical services based on outcome. I donít know how to do this. We should not exclude Medicare as an alternative for providing universal healthcare because of its runaway costs. We should solve the cost problem. Many countries that have universal health care have learned how to contain costs. They should provide us with a model or ideas on how to solve our runaway cost problem. A single payer system means the elimination of the private health insurers. I think this is a good thing.
Profit Motive Conflicts with Ethical Practice
Private health insurersí profit motive is in conflict with providing good healthcare for all. Private insurers are much more likely than Medicare to ration healthcare by denying coverage because their primary reason for being in business is to make money and to increase shareholder value. Every claim they pay comes out of their bottom line. In addition, private insurers spend billions of dollars a year that do not provide one pennyís worth of healthcare, but their customers pay for these billions in their insurance premiums. These non-healthcare expenditures include advertising, high executive salaries and bonuses, infrastructure and reporting needed to maintain their status as public corporations, lobbying, contributions to political campaigns and of course, their profits. Eliminating these billions will reduce the cost of health care. A single payer system will also impact the pharmaceutical companies. As is done in other countries, a single payer system will have the clout to negotiate drug prices. This will also help reduce the cost of healthcare. This will not necessarily be detrimental to drug companies. Though they may be paid less for each drug dispensed, universal coverage will increase the size of their market by providing millions of new customers.
How do you pay for universal coverage? There is a combination of ways. The most important and most pressing is figuring out how to compensate medical practitioners in a manner that will not give them incentive to perform unnecessary services. One small part of this is tort reform to limit the cost and awards of malpractice suits. Perhaps all medical organizations should pay a fee based on a percentage of revenue into a malpractice fund. There could be expert committees to adjudicate claims and all patients would have to agree to abide by the decisions of these committees. This would eliminate law suits and the need to purchase malpractice insurance. The next source of money to pay for universal healthcare comes from premiums and taxes. Corporations no longer need to pay premiums for current and past employees to private health insurance companies. Instead, they will pay premiums only for current employees into Medicare. These premiums should be less than the corporations are now paying thereby giving them some cost relief. The premiums should also be scaled so that very small companies pay very little. All these premiums should be treated as taxable income to employees. This will generate billions of tax dollars going into Medicare. I am on Social Security. Medicare premiums are deducted from my Social Security benefit every month. These deductions are part of my income and they are taxable. The elimination of all the non-healthcare related costs now spent by private insurers also constitutes a cost reduction in the healthcare system. I do not know if these measures are budget neutral, but I think they go far in paying for the expanded Medicare. Medicare coverage to everyone can be phased in over a period of years by lowering the age for acceptance into Medicare by something like ten years per year. This would allow for a six or seven-year transition into the new universal coverage. No new bureaucracy need be created. It already exits. It would be gradually expanded to service the larger work load and new staff can be acquired from the slowly winding down private insurers. The insurers would have time to change their business models. No new laws need be written except for some changes to the tax code. Why canít Congress just do the right thing for the nation and its people and adopt something straightforward and simple such as this?