Tennessee echo opinion - support primary health care

An echo opinion letter published in the Oak Ridger in Oak Ridge Tennessee:

As part of the United Nation’s sustainable development goals, all nations committed themselves to achieving universal health care by 2030. The Global Burden of Disease Study shows that as developing countries approach this goal, deaths from infant mortality, HIV/AIDs, malaria, and TB (tuberculosis) have fallen in its wake. 

In fact, more disability and death are now coming from the undiagnosed or under-treated hypertension and diabetes that plague rich nations.

It is clear that more emphasis on primary care, as well as expanded access to at least 44 essential surgical procedures would transform the world’s health systems.

In just 10 years, using five-member primary-care teams, Costa Rica’s population moved from health coverage of 25 percent to 93 percent without a per capita cost increase. 

Implemented in stages, it clearly produced improved health outcomes. 

Similarly, Thailand has universal coverage with comparable health outcome of rich nations. For this, they spend just $220 each year per capita. The U.S. spends $10,350 and leaves more than 10 percent of its population uninsured.

A study of 12 European nations shows that improved access to health care is not just a product of a nation getting richer, but it actually makes a nation richer. For example, almost a third of the increase in Britain’s Gross Domestic Product (GDP) over 200 years has been attributable to improving health care.

The U.S. system has many flaws, as well as poor overall health outcomes. Despite this, it has by far the world’s most expensive care. Additionally, it is the only rich nation without universal or near universal coverage.

Between 1975 and 2010, the number of U.S. physicians increased by one and a half times while the number of administrators increased by 32 times. Hospital and drug costs are 60 percent higher than in European nations.

There are several proposed starting points to help fix healthcare in America. First, we need to expand primary-care access by better use of secondary providers like nurse practitioners and physician assistants and shift 10 to 20 percent of the exorbitant reimbursement to many medical specialists toward primary-care physicians and secondary providers.

We need to control dramatic variations in drug costs and services provided by hospitals. For example, an appendectomy may cost between $1,500 and $183,000. A 90-day supply of three generic heart drugs may cost between $30 and $1,400.

About 40 percent of the out-of-pocket expenses paid by patients are wasted. This money should be pooled for greater bargaining power in controlling costs. Moving closer to a single-payer system is the only way to achieve this. According to the Kaiser Foundation, the majority of Americans now favor a one-party payer.

Medicare could be expanded to younger ages. Medicaid could be expanded to those too rich for subsidies, but too poor for private insurance.

It's time to complete health care reform ~ support access to primary care.

Half of Americans now have coverage through their employers. A Medicare plan could be expanded to everyone else and employers could be required to offer a comparable option. We could move to re-insurance where the government would pay all out-of-pocket expenses to those with other insurance.

We could start with well-endowed plans to a small group and expand it or provide a small core of benefits to everyone and add to it as cost savings are realized.

It is time that healthcare special interest groups, political stalwarts for the status quo, and self-proclaimed defenders of freedom step aside and let the rest of us implement what has already been proven to work.

William Culbert is an Oak Ridge physician who has a practice in Clinton (Anderson County) Tennessee.