This is the second in my series of '4 question interviews', today with Dr. Jonathan Kotch,MD Professor in the UNC School of Public Health and an active member of Physicians for a National Health Plan, which advocates for a single payer health system in the United States. Like all 4 question interviews, it is published in full.
Question 1. What is the biggest problem facing the U.S. health care system?
The biggest problem facing the U.S. health care system is that it is immoral. It violates a national and international consensus that health care should be a human right. International agreements such as the U.N. Declaration of Human Rights (1948) and the Alma Ata Declaration of the W.H.O. (1978) clearly articulate that health care is a right, and recent polls in both the U.S. and N.C. have documented that a majority of those polled agree.
One can argue whether We the People intended to include health promotion when the U.S. Constitution was established in order to “Promote the general welfare”, but there is no doubt that, in 1789 or 2009, society cannot enjoy a sense of general welfare if its members are not healthy. The fact of the matter is, compared to other western developed nations and some middle income nations as well, the general health of the people of the U.S. is poor. Part of the reason for this problem is that the indigent, the sick, and minorities are systematically excluded from early access to the health care that more privileged members of our society enjoy. Instead of need for care being the principle criterion for allocation of health care resources, ability to pay is the criterion. This is immoral.
would it look like?
· Access to appropriate health care is a right. It isn’t something you have to sign up for, and no one would need to be forced to join or penalized for refusing to join.
· Benefits would include all outpatient and inpatient services deemed necessary and appropriate by a Public Commission, answerable to voters, in consideration of available evidence and professional standards of practice.
· The system would be financed by a progressive system of income and payroll taxes, with the result that small businesses would pay proportionately less that large businesses, and low income individuals would pay proportionately less than the wealthy.
· All current providers, solo and group, private and public, would be eligible to participate, provided that they are not-for-profit. Patients would have free choice of their primary health care provider.
· Providers would be compensated based on a fee schedule negotiated between the Commission and their professional associations.
· The system would reward primary and preventive care and eliminate incentives for specialty and tertiary care. Access to specialty care would be by referral only.
· Similarly, outpatient care would be encouraged, and inpatient care discouraged. Hospitals and other institutional providers would be given an annual budget within which they would be required to operate.
· Quality would be assured by the appointment of a Quality Board to monitor the delivery of health care services. The Board would assure that care is available to all regardless of age, race, ethnicity, income or geographical location.