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Health Care Policy – Faith-Based or Evidence-based?

From the Ellsworth American
October 20, 2011
By Philip Caper, M.D.
Brooklin, Maine

Senator Brian Langley’s recent commentary praising the newly enacted law (PL 90), that replaces Maine’s carefully crafted system of health insurance regulation with a more “market-based solution” deserves comment.  He evidently has a great deal of faith in the role of markets and competition in health care.  He is apparently unaware that we in the US have been conducting the world’s leading experiment in market-based healthcare for over 30 years.  No other developed country in the world relies as heavily as we do on market forces to provide access to affordable health care for their people.

That experiment has been a spectacular failure.  It has resulted in by far the highest health care costs in the world that continue to spiral out of control. Despite our high costs, we suffer from having the highest proportion of uninsured citizens of any developed country. Medical costs are the leading cause of personal bankruptcy in America, and it is reliably estimated that over 45,000 Americans die unnecessarily each year due to impaired access to medical care.

Senator Langley’s confusion is understandable.  LD1333, the legislation leading to the enactment of PL 90, was rammed through the legislature along party lines without adequate time for study (except perhaps by those who crafted it), without hearings, without meaningful debate, and without giving the Superintendent of Insurance the chance to assess its likely impact on the people of Maine.  It was the most irresponsible exercise of political brute force I have witnessed in my 45 years in health care.

Although a few relatively young, healthy and employed people may see a slowing in the rate of increases in their health insurance premiums, many older and less healthy Mainers, especially those living in rural areas, will pay a heavy price.  They will see massive increases in their costs of health insurance to the point of unaffordability, or will be dumped into a publicly administered “high risk pool” that will likely soon become under-funded.  The new law has created open season for insurance companies to sell skimpy policies to unsuspecting Mainers that will prove to be inadequate when the time comes to use them.

This law does nothing to slow the explosion in the costs of medical care.  These costs are driven by inappropriate overuse of expensive (and lucrative) diagnostic and therapeutic technologies (often without any clear evidence of benefit), windfall profiteering due to unnecessarily high prices by corporations selling health care products and services, and massive inefficiencies in the way we finance and pay for health care.  These factors are not unique to Maine, but we certainly suffer from them.

We need less, not more competition among health insurance companies.  Competition does not work in medical care as it does in normal markets.  The proof is in the fact that our current market-based system is failing. 

We need to learn a lesson from our Canadian neighbors who have a single publicly managed insurance system, yet retain free choice of provider. Despite the fact that Canadians may have to wait somewhat longer for elective procedures than people with good health insurance in the US, they apparently believe the advantages outweigh a little inconvenience. Their system is far more popular than is ours. If you ask Canadians whether they would trade our system for theirs, most simply laugh.  No Canadian politician who wants to stay in office, including their current conservative government, dares to propose tinkering with its fundamentals. 

Virtually every Canadian is covered, and bankruptcy due to medical costs is essentially non-existent.  Almost every measurable health outcome of their system exceeds ours in quality.  What’s not to like?

All other wealthy countries have similar systems. Their overall healthcare costs average about half of ours.

It’s time to change the way we think about healthcare in America.  We need to move away from faith-based policy and toward policy based on evidence.  It’s time for an improved Medicare-like system for all Mainers.