COLUMN: Single-payer health care system would save lives, money

Friday, April 15, 2011 | 5:41 p.m. CDT; updated 7:12 p.m. CDT, Sunday, July 3, 2011

The 2001 terrorist attacks on the World Trade Center killed 2,751 people. In 2001, it has been estimated that more than 18,300 people died due to lack of health insurance, according to the American Journal of Public Health.

Where was the outraged horror that six times as many people died because they lacked health insurance?

Repealing or preventing health care reform will likely kill many more people than terrorist attacks. From 2001 through 2010, about 3,450 people were killed in terrorist attacks that took place in the U.S. or against American targets. A study from the Department of Medicine at Cambridge Health Alliance, based on data from 2007-08, estimated that 45,000 adults died in the U.S. from a lack of health insurance.

Here is the missing headline to celebrate the recent first anniversary of health care reform: "No insurance: 45,000 deaths in first year."

Since 2001, the U.S. has spent more than $1.2 trillion on the war on terror. From 2001-08, almost nothing was done to address the lack of access to health care. Late in 2008, the health care debate started that led to the passage of the Patient Protection and Affordable Care Act in March 2010. The good news is the act will save lives. According to a Congressional Budget Office analysis, by 2019, the law will reduce the number of uninsured by 32 million. This will save approximately 32,000 lives. The bad news is the act will leave 23 million people uninsured, resulting in approximately 23,000 deaths. So, while the proponents of the act were busy defending the legislation from false charges, such as death panels, they neglected to consider the amount of lives that would be saved and how many will still die.

The outcry would be deafening if the U.S. instituted an anti-terrorist policy that chose to leave more than 15 percent of the population unprotected.

The Protection and Affordable Care Act will not reduce the percent of GDP spent on health care, and this will continue to drag down the U.S. economy. The act will increase GDP spending on health care from 20.8 percent to 21 percent because it will cover more people. In terms of spending, the act is roughly equal to the current system.

What has been lost in the debate over health care reform is that it would be possible to implement a single-payer system that would cover everybody, prevent those 23,000 unnecessary deaths and reduce health care costs by 40 percent. In 2008, France, which has a single-payer system, spent just over 11 percent of its GDP on health care. In the same year, the U.S. spent 16 percent of its GDP on health care. France is ranked first in health care, while the U.S. is ranked at 37.

The difference in per capita spending is even worse for the U.S. While the U.S. spends $7,538 per capita, France spends $3,696. The U.S. spends more than twice as much on a per capita basis to achieve our dismal rank of 37.

Economic efficiency can be defined as allocating resources in a manner that minimizes waste and inefficiency. While some believe private enterprise will always be more efficient than the government, when it comes to health care, they are wrong. In every developed country that has a national health system, the percentage of GDP spent on health care is substantially less than the percentage spent in the U.S.

The tragic truth is terrorists do not have to resort to violent acts against the homeland when the lack of access to health care is so much more effective at killing Americans.

Joseph Sparks is master's candidate in journalism at MU. He is planning a career in public relations.

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Kathy Snowberry April 15, 2011 | 8:14 p.m.

Want to bet you won't get any comments on this site - at least none from the regulars?

You need to send this to Gov Nixon, and maybe his aide can explain it to him.

(Report Comment)
Ellis Smith April 16, 2011 | 8:35 a.m.

It's not the idea of a "single payer" that bothers me - it's WHO that "single payer" is obviously going to be. (Use of "single payer" is a device to keep from saying "federal government," because those who are pushing the idea know the words "federal government" turn off an increasing number of Americans.)

Reasonable people, when they go to make a major purchase, spend a little time investigating the track record of the "firm" from which they propose to buy that item or service.

What is the track record of the proposed provider? Has it, in the past 50 years, shown ANY degree of fiscal responsibility? Doesn't it already have two major social programs that are in actuarial trouble?

BTW, Kathy Snowberry, you've lost your bet! I'll be glad to accept donations to me, and I will apply them to my next PRIVATE health insurance premium (United Healthcare). But while I'll accept your donations, I won't ASK you or others to pay for my health care.

(Report Comment)
Michael Williams April 16, 2011 | 9:00 a.m.

J. Sparks: You have any confidence intervals on the number of deaths due to uninsurance? The paper by Wilper does list some confidence intervals, but they relate only to HR values. There is nothing about whether 35375 deaths is an exact number (it isn't) or what the C.I. is. We are left to wonder if this value is accurate to within an order of magnitude, perhaps off by a factor of 2, or 3 or 5, or "exact" (it isn't). What is the precision?

Also in the paper by Wilper (Dec 2009), I was awestruck by the following introductory sentence to the Discussion section:

"The uninsured are more likely to die than are the privately insured."

I got news for this author. The uninsured are JUST AS LIKELY TO DIE than are the privately insured. Doctors have a 100% failure rate in their profession. Even proponents of "natural" healing die of "natural" causes. The only issue is timing.

Poor writing and a bad reference.

(PS: I don't necessarily disagree with the gist of the Wilper article or your article. But I do take exception when a peer-reviewed article and your subsequent journalistic article presents numbers like these without an estimate of error or range based upon statistical probability. The "peers" in the article should have caught this, and you the journalistic author should have an understanding of statistical precision and accuracy when you report seemingly "accurate" values. Without estimates of precision, we readers are easily misled emotionally and swayed by something that just may not be true.)

(Report Comment)
Ellis Smith April 16, 2011 | 10:22 a.m.

Good comments, Michael. As one with some knowledge of confidence intervals, I'm tempted to cite the first rule of statistical inference: No matter how the data may be subsequently "messaged" and presented, the results can never be any better than the validity of the data themselves. GIGO. Years ago it took time to obtain the "GO"; today we can obtain the "GO" very quickly. :)

Gee, "Kathy Snowberry," you lost your bet again! Michael is most certainly a "regular."

(Report Comment)
Kathy Snowberry April 16, 2011 | 12:28 p.m.

Ellis - I am sincerely happy to have lost the bet. I think that many of the regulars on this site offer up some of the most intelligent and thought provoking comments, comebacks and insights on issues. I just wish ya'all would comment on more of the topics than you do.

(Report Comment)
Kathy Snowberry April 16, 2011 | 1:56 p.m.

Ellis - 'single payer' is different from 'single provider'. In the proposed HC reform, you would be free to keep UHC or switch to whatever firm you think best. You would also be free to spend more if you wanted more/better coverage than available through the single payer provisions.

As for the fed being the 'single payer', it's proven it can't be trusted so why go there. That's one of the changes I wish the Republicans would focus on, rather than trying to toss the program completely.

Regardless of the statistical precision, I think Spark's comparison on spending raises a good point on the Fed's current priorities and distribution of our $.

(Report Comment)
Michael Williams April 16, 2011 | 2:07 p.m.

KathyS: One of the reasons the "regulars" don't comment a lot is because there are some rather obtuse sharks (spelled t.r.o.l.l.s) in the water....and who needs that? Besides, many of us have lots of other fun things to do. Indeed, I believe this is one of the big reasons why posting on this site is not as heavy as, say, the old Trib site. Anonymous folks for some reason have too much time on their hands.

You also stated, "You would also be free to spend more if you wanted more/better coverage than available through the single payer provisions."

I have very serious doubts that my ability to purchase more/better coverage than someone else will persist under a liberal agenda. Such a notion is not a philosophical "fit".

I agree with you the feds can't be trusted with such things. The feds are quite good at items such as national defense and roads, but socially? Nope. This is why I am such a huge proponent for privatization of SS....that and the fact SS would then be heritable.

(Report Comment)
Ellis Smith April 16, 2011 | 3:09 p.m.

If you want socialism here in North America that at least SORT OF works, consider moving to Canada. It's a nice country, the natives are friendly, there are jobs, and trains are actually fun to ride. You may have to learn to appreciate ice hockey. On the plus side, Canada is growing wealthy selling energy, in various forms, and minerals to the United States.

Don't like winter? Try Vancouver, where the winters are pretty much the same as in Seattle or Portland and the summers are pleasant. Winnipeg is a VERY nice city, but you should also own a home in a warmer place to repair to from November to April. :) Winters are less severe in Edmonton than in Winnipeg (see a map).

(Report Comment)
Michael Williams April 16, 2011 | 3:14 p.m.

Ellis: I could never move to Canada.

They talk funny.

Good fishin', tho.


(Report Comment)
Kathy Snowberry April 16, 2011 | 3:51 p.m.

I was thinking, instead, of Switzerland. Lived and worked there for awhile, and think it would serve well as a model.

(Report Comment)
Ellis Smith April 16, 2011 | 3:52 p.m.

You're correct, Michael, they DO talk funny.

It's better to live here in the United States, where no one talks funny. ;)

For a unique train ride, try VIA Rail's "Hudson Bay" train from Winnipeg to Churchill, Manitoba. Full meal service, and you can book a roomette at what I consider a reasonable price. Leave Winnipeg on a Sunday night and you arrive in Churchill Tuesday morning, nearly 1,000 miles. Take sufficient reading material (a novel perhaps). You start on the prairie; the next morning you are in the woods; the next morning you are rolling across treeless tundra.

You can also fly to or from Winnipeg. There are no roads to Churchill: everything and everybody comes and goes by either train or plane. Best times to go: late October and early November, when the polar bears are congregating to go out of the ice, and in late June and early July when wild flowers are in bloom. Accommodations are decent, but you need to book well in advance. Churchill resident population <2,000. (It's a deep water grain shipping port. The tracks used to belong to Canadian National but has been purchased by a rail firm in Colorado. So when you ride this train the Canadian government is passing some of the fare back to the United States.)

(Report Comment)
Gregg Bush April 16, 2011 | 4:04 p.m.

Great article, Joe! I find it peculiar how many Americans admit defeat when it comes to healthcare. Just because the rest of the industrialized world can have better health outcomes for less money, somehow these defeatists believe that we're just not smart enough.
Well, I believe in America even if these saboteurs do not. Their "Can't Do" spirit won't get me down. In their twisted world, physicians are charged with prolonging life indefinitely (phony 100% failure rate statistic).
To be clear, I would never, ever in a million years use hyperbole.
But in reality, your article is spot on.

(Report Comment)
Michael Williams April 16, 2011 | 4:12 p.m.

Kathy: Be careful of Switzerland. I understand they are quite careful about who becomes a citizen or stays very long. They are quite discriminatory. A German lady told me this. Do you know the exact rules you could share?

Ellis, I do like riding on trains and would like to take the TransCanada. But other than an every-once-in-a-while fishing trip to Ontario, I won't go there because they won't let me take my handguns. I'm in revolt. It ain't the only place I won't go an' spend money.

(Report Comment)
Michael Williams April 16, 2011 | 4:16 p.m.

Ellis: As for folks speaking funny, get me around someone from the deep South and...voila...3 minutes later my words slow way down and all my sentences end on an upswing.

Contagious as the measles.

I won't ever say "Ayah", tho. Nope. Never gonna happen, eh?

(Report Comment)
Ellis Smith April 16, 2011 | 4:32 p.m.

@ Kathy Snowberry:

If you lived in Switzerland then you should be familiar with their interesting form of government: the FEDERAL government has - by design - rather weak and limited powers and the individual cantons hold a surprising amount of power.

Their government is in reality exactly what they call it, a confederation. Our government is NOT a confederation. How much present federal power do you propose to give back to the 50 states? I hope it's a lot.

A weak federal government? So long as we aren't talking military matters I'll vote for that.

There are four official languages in Switzerland (one of them doesn't amount to much as far as the number of speakers is concerned), yet people seem to get along with that.

There are only two official languages in Belgium, but those folks don't seem to get along very well.

There are two official languages in Canada (aside from Native American languages, including the Inuit), but there is a certain amount of "linguistic friction." Many Canadians I've talked to regard Quebec as a pain in the ass, and I don't doubt the feeling is reciprocated.

Who knows, we may soon have two official languages in the United States. I'm not counting Native Missourian.

(Report Comment)
Kathy Snowberry April 16, 2011 | 5:16 p.m.

Michael: Yes, Switz was highly disciminatory - was trying to improve on some issues - don't know the current status. One attitude I best recall, among 50+ year olds - was that 'normal' women stayed home and did not work, unless happenstance forced it upon them. Also - older highly educated professional males had peculiar attitudes about women as peers. Many in the company I worked for, initially, refused to meet with me and instead thought I should meet with their female secretaries. Business dinners were a hoot - the older males felt they needed to bring their wife to add a layer of decency to meeting with me.

Homeless people were not allowed in the cities, but welcome in the open rural areas - thus you never saw the homeless, or unclean. Also, no flushing the toilet after 9pm, and if you were caught washing your car on a Sunday you could do jail time (well, at least pay a hefty fine). Younger people seemed to be aware of needed changes, and with their form of government I imagine many changes have been made for the better.

I could walk the streets at 2am, or park my shopping cart at the entrance of a market, and not worry about being mugged or robbed.

(Report Comment)
Michael Williams April 16, 2011 | 5:42 p.m.

Kathy: Yeah, I bet you could walk outside after dark. Heck, everyone has an automatic rifle! Mandatory!

If memory serves, if you didn't speak one of the 4 official languages, you didn't become a citizen and I think your allowed time in-country was shortened, but I could be wrong about this. If this is correct, there are some European practices we should mimic.

I won't make a joke about "'normal' women stayed home and did not work" because I get into enuf trouble as it is around here. An' someone might not think it was a joke.

As far as the older highly educated professional males and their peculiar attitudes.....yeah, those German-male types DO have this "head in oven, buns in bed" thingie goin'. I used to do chemistry work for a group of mainly women doing the lab contracting for BASF. Their bosses, from the Swiss/German arenas, were hell-on-wheels. Wasn't pretty at all the way the women were treated.

I'd have a real problem with not flushing the toilet after 9pm. So would any downwind neighbors. Especially if I was usin' one of those US greenie-wienie low-volume flushers.

(Report Comment)
Kathy Snowberry April 16, 2011 | 5:50 p.m.

Ellis: Yes, and I think their form of Federal government is appealing. It sets laws and regulations that might be deemed 'general operating characteristics', while trying to distance itself from over-regulating people's lives. The cantons, through a referendum or something like our voter initiative process have a lot of control.

No CAFOs allowed or 'battle breeding'. No electrical air conditioning - but water-cooled is common. These things the canton's can't change (as I recall).

Military matters apply to everyone - as long as it's strictly homeland security. As I recall, every able man and women had to participate in military training, and stand prepared to defend their country if the need arose. All homes that I visited had the equivalent of a 'bomb shelter', fully stocked with weapons and living supplies.

I'm not certain there were any 'official' languages - let alone 4. Some areas spoke swiss-german, others french-german, the 'elite' sometimes spoke high german. As I recall, the swiss referred to most of these as 'dialects'; implying they viewed these as the same language with minor local variations. Everyone I enncountered spoke enough english that I had no problems.

Minimal federal government seems to work for them. As for here? Better to ask Ron Paul (although I think he's a tad extreme).

I have spent some time working in Canada (Toronto) - not much time spent on vacationing.

(Report Comment)
Kathy Snowberry April 16, 2011 | 6:27 p.m.

Michael - Work-life balance there was wonderful. To work by 9, mandatory coffee/social break at 10, lunch 11-1, another mandatory break at 2, then off to the library (for real) by 3. Yet productibity was amazingly high - as was morale. What I accomplished in 1 year there would take 5+ here. Wonderful respect for innovation, and what it takes to achieve it.

I do not recall the language requirement exactly, but I think it was german. Can't recall the exact requirements for becoming a citizen - but as I remember, education level and occupation were the top. Occupationally, you had to be in a field for which there was a 'critical' shortage. Or, maybe I'm confusing this with requirements for a short-term work permit.

Certainly did enjoy living there. But them, I lived in an 'americanized' apartment, and had real air conditioning and could flush whenever I wanted.

(Report Comment)
Derrick Fogle April 16, 2011 | 7:07 p.m.

Here's a thought: Under "Single Payer" - i.e. Universal Medicare, how do you think the program would be administered? Here's a hint: the existing insurance and delivery system will probably accept contacts...

IMHO, don't expect "single payer" to fix any of the actual problems. I think the government run programs are easily as efficient as the private sector, but not significantly more. This is where the already stated adage comes in: What is taken as profit in the private sector, is lost to incompetence and corruption in the public sector.

As I've pointed out before, they all use the same fundamental "Administrative Warfare" claim submission / denial system now. I still assert that the cost of this delivery regulation mechanism is probably at least 25% of the total cost of healthcare delivery. Ditching the whole payment system would save a ton of money, but that's not what we're talking about.

We're talking about the government essentially taking over national payment collection, and contracting out the distribution and regulation to the existing players using the existing system. Think efficiency will improve? I'll spot you 2-3%. After that, we get back to the bigger problems.

It's rather chilling to consider that lowering the cost of healthcare may well mean letting people die. The rise of the Medical Industrial Complex is one of the great bubbles of our time, rivaling any other. Despite the incredible longevity, it's trajectory is unsustainable, and it will eventually pop.

Quite frankly, Ryan's death voucher plan would be a very effective pinprick against the healthcare bubble. But even without that, I think the healthcare industry will collapse under it's own weight soon enough.

Stock up on health. You'll need it.

(Report Comment)
Ellis Smith April 16, 2011 | 9:49 p.m.

Another interesting thing about the Confederation of Helvecia (aka Switzerland): they were one of the last - if not the last - "advanced Western democracies" to give women the right to vote. Don't remember the exact year, but as late as the mid-1950s women still couldn't vote.

States' (canton's) rights, and the women can't vote. Sounds like my kind of place!

I've only been to German-speaking portions of Switzerland; I don't speak French or Italian, but there are lots of Swiss who speak English.

Kathy, you can also walk the streets of downtown Chicago at 2 AM with impunity - provided there's a platoon of you, all heavily armed. That would allow you to fend off any "neighborhood organizers" you might encounter.

(Report Comment)
frank christian April 16, 2011 | 10:48 p.m.

10 years or so ago my wife suffered an ankle injury in Paris, which caused hospitalization for three days in Moulin,France, and a recommendation that she be examined in Switzerland. She was examined in Berne and the pretty young *Surgeon* that looked at her ankle advised us that she was preparing to leave for a two year training period at a hospital in Dallas Texas (that's USA).

Sorry to interrupt, but doesn't it seem odd that countries with such advanced universal health care are sending their top providers to our poor, backward country for training? How does it go? just sayin'....

(Report Comment)
Ellis Smith April 17, 2011 | 2:00 a.m.

You are not interrupting, Frank. Isn't there an old saying (there are LOTS of old sayings) about one man's meat being another man's poison? Or another old saying about how the grass always looks greener on the other side of the fence? Or, to bastardize yet another old saying, what's good for the goose ISN'T necessarily good for the gander [in particular as regards socialism].

I believe I misspelled "Helvetia," in a post above. It's true, engineers cannot spell.

(I think the pain killers have started to kick in and I can now go back to bed.)

(Report Comment)
Bob Haiducek April 17, 2011 | 2:29 p.m.

Joe, Regarding the number of Americans who die due to no health insurance.

Although that's an interesting statistic, a team of University of London researchers came up with another interesting statistic: 101,000 unnecessary deaths of Americans ... one every 5 minutes ... due to our poor performance on amenable mortality: the ability to prevent deaths under age 76 due to preventable diseases.

The U.S. was 15th out of 19 countries (2003 report).
Now we are 19th out of 19 countries (2008 report).

Related links:
Real People (but unnecessary deaths)
Amenable Mortality: U.S. vs. six countries

- Bob the Health and Health Care Advocate

(Report Comment)
Austin Fax April 17, 2011 | 7:17 p.m.

Can we just think of this statement logically?

“In 2001, it has been estimated that more than 18,300 people died due to lack of health insurance, according to the American Journal of Public Health.”

Now, being a busy man, I don’t have much spare time on my hands to read autopsy reports. But can anyone tell me the last time they saw an official cause of death that read, “Patient X passed away at 3:01 p.m. due to a lack of health insurance?”

I’ve heard of death from heart conditions, lack of oxygen to the brain, and blood loss, but never have I heard of a death from health insurance coverage.

Physicians take the Hippocratic oath for a reason. Namely, they aim to treat patients regardless of their ability to pay for said treatments. That would lead me to believe this statistic is ludicrous.

Which brings me to my second point. Why did the 18,300 mortalities mentioned above not have health insurance? Were they elderly and lacked health coverage? I thought that was what Medicare was for. How about poor? I would’ve figured they applied for Medicaid.

So, what was the reasoning for not having insurance? Were these government programs not good enough for them? If not, are we to believe government run single-payer health insurance would magically solve all the problems found in those two programs?

Instead of looking at the lives that could’ve been saved had these people found unlimited resources in their health care; we should look at the lives saved by the innovation of the private market in health insurance.

(Report Comment)

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