Physicians for Social Responsibility on Healthcare Reform in the United States
For physicians, and indeed for all health workers, promoting health for all is a clear social responsibility. Attention must be paid to social determinants of health, including the science and art of public health, and also the system of providing medical care, a major contributor to good health.
The United States devotes enormous resources to medical care, well over 50% more per person than any other nation -- yet it ranks 45th in the world in life expectancy and 33rd in infant mortality. Deep disparities in health outcomes and access to care exist in the United States. For instance, former Surgeon General David Satcher estimated that the "Black-White Mortality Gap" results in more than 80,000 excess preventable deaths each year among African-Americans. The Institute of Medicine estimates as many as 24,000 people die each year in the United States for lack of health insurance.
Too many communities find basic medical services -- like emergency care, primary and preventive care and home care -- stretched to the breaking point. In spite of highly trained and deeply dedicated specialists, generalists, nurses and technicians, the United States ranks 19th out of 19 industrial nations in deaths due to treatable conditions. The words "crisis" and "collapse" have been used to describe these failings of medical care in the United States by many leaders and organizations, for example, the Institute of Medicine, the American Public Health Association and the American College of Physicians.
Dominated by a system of employer-sponsored private health insurance, healthcare costs have soared, the number of uninsured have burgeoned, quality and safety have declined, disparities have widened, and patient autonomy has been eroded by systemic roadblocks to free access to care – at all a great cost to the nation's health. Since the enactment of the Medicare program in 1965, efforts at reform, at the federal as well as the state level, have continued to depend upon private health insurance and the “marketplace”. These piecemeal efforts have not only failed to improve access to healthcare but have succeeded , one-by-one, to benefit the insurance, pharmaceutical, and other corporate interests that dominate the highly profitable healthcare industry. Meanwhile Medicare has remained as a consistent, workable, efficient model for a system of public financing and private delivery of medical care.
The number of uninsured have burgeoned despite the enactment of the Medicare program in 1965 for individuals enrolled in Social Security and the steady growth in the Medicaid system instituted for the impoverished. With unprecedented loss of jobs in the United States anticipated through at least 2011, growth of those uninsured is likely to grow even faster.
A socially responsible system of medical care for the United States would ensure the right of access to comprehensive medical care for all and also protect the relationship between patients and providers. A socially responsible system of medical care would require attention to the social determinants of health and would apply the science and art of public health. Universal access to comprehensive care will improve the health of the United States citizenry and lessen inequalities and discrepancies in care. The experience of other developed countries indicates this can be done with great cost savings.
A socially responsible system of medical care for the United States would not tolerate profiteering at the expense of the sick. It would provide a means for the public to set health priorities for the nation.
We contend that healthcare reform should create a program that will ensure access to primary and preventive medical care to all inhabitants of the United States. Creation of a universal comprehensive primary and preventive care program in the United States that also addresses the major social determinants of health would be an investment that will pay dividends in improved health, increased productivity, and reduced cost for care as is enjoyed by developed nations except the United States.
Single-payer reform offers the minimum incremental change required for the United States system of medical care: to improve the care of patients, lessen inequalities and disparities in care, defend and expand patient choice and autonomy, redistribute resources toward care and away from bureaucratic waste, profit-making and personal gain and thus reign in costs -- while providing care for every inhabitant of the United States.
We believe that the major concern in the healthcare reform debate should be the creation of a public program that will pay for the medical care for all, to mitigate the tragic progression of disease and loss of life, as well as the financial burdens that are presently placed on all segments of our society when individuals have no, or limited, health insurance.
To move toward a socially responsible system of medical care in the United States, private and employee-based health insurance must be replaced by a program of public financing, exemplified by a single-payer model.
Access to comprehensive healthcare is a human right. It is the responsibility of society, through its government, to ensure this right.
Physicians for Social Responsibility suggests that people who would like to learn more about a proposal for single-payer reform seek out physician-advocates of the Physicians for a National Health Program (PNHP), or review HB 667, presently in Congress.