maldistribution of personnel and facilities. The medical market mechanism is incapable of meeting the real health needs of the public. Failure of Private Health Insurance Private health insurance has provided some needed protection against health costs to certain segments of the population, including labor unions. But it has failed, after a quarter century of effort, to provide a major mechanism for financing health care for all Americans. A survey made by the National Center for Health Statistics indicates that of the 177 million civilian non-institutionalized Americans under 65 in 1968, 36.5 million had no private hospital insurance whatsoever, and 38. 8 million had no surgical insurance. Thirty million have no private health insurance whatsoever. And, for many of those with coverage, payments are restricted to limited covered services and often do not meet the full charges involved. Frequently, as a result of insurance, the health services provided are chosen with reference to the scope of the individual's insurance coverage rather than the most appropriate means to meet actual health care needs. For example, distressingly little emphasis has been placed on ambulatory, diagnostic or preventive care. In fact, according to the National Center for Health Statistics, only about half of the civilian population under 65 had any coverage for x-ray and laboratory examinations outside the hospital; 58 percent had no coverage for physician office or home visits, and 61 percent had no coverage for prescription drugs outside the hospital. Even if the coverage were universal, private health insurance offers little incentive toward organization, economy and efficiency in the provision of health services. Private insurance has had virtually no impact on overcoming "administered" health prices. If anything, it has accelerated the already too rapid health care price inflation and has failed to improve the performance of the delivery system. And the Medicare program, providing urgently needed coverages to the elderly, has further stoked the fires of health price inflation, because its insurance design is an exact copy of the private health insurance model. The marketing of inappropriate but saleable packages of private health insurance is today becoming even more difficult as costs rise and consumers demand more comprehensive levels of protection. Moreover, because of the vast duplication of insuring agencies in the field, the nation is asked to finance activities totally unrelated to their primary function the distribution of the costs of care over large numbers of people. For example, of the approximately $1.7 billion now spent on administration by private carriers, the Committee of One Hundred for National Health Insurance has estimated that $1.1 billion is attributable to duplication of administrative systems, competitive practices and expensive advertising. Private health insurance is paying just over a third of the only some eight percentage - total private consumer health bill today points more than it was ten years ago. At that rate, it will be almost the year 2000 before insurance covers even two-thirds of the U. S. private health care bill. Some groups have asserted that the "health crisis" can But be solved by broadening the scope of private health insurance. private health insurance has not been a creative force. It has shown little interest in quality or cost control or improved organization of services. Realistically assessing the self-interest, traditions and values and institutional limitations of the voluntary private health insurance sector, it is totally unrealistic to expect that it could be a force toward rationalization of the health care system. Given the real interests of the voluntary private health insurance sector, this is not surprising. Blue Cross is exactly what its motto proclaims "the hospitals' plan" and its sister organization, Blue Shield, is as it proclaims, "the doctors' plan". Nowhere, unfortunately, is there a consumers' plan. The commercial companies are interested in making money in the medical marketplace and have succeeded admirably in this endeavor, although times are hard right now. Voluntary or compulsory health insurance through private carriers cannot be considered as the vehicle for organizing, extending and financing health care for the American people. America's Record of Ill Health Amid the existing jumble of frequently conflicting - official health policies and programs and an unrelated, costly and unsatisfactory system of private health insurance, one consistent trend has emerged Americans seem determined to spend more on health services than any other nation in the world. The cost of health services in the 60's increased at a rate of more than twice the rise in the overall consumer price index. If cost could be equated with quality, then America would be the healthiest nation in recorded history. We spend more money on health and medical care than any other people in the world: $63 billion a year in 1969. That represents a little over 6. 7% of our Gross National Product and the percentage continues to rise. - While the cost of health care in the U. S. has been escalating at a staggering pace, we have witnessed a relative decline in many well known indices affecting poor quality and the scope of care and services. Many other nations, far less wealthy than the U. S., have lower rates of infant mortality and longer periods of life expectancy. Most of the major industrial nations of the world exceed the U. S. in the universally accepted indices of a people's health. The comparison is shameful: In infant mortality, among the major industrial nations of the world, the U. S. trails 12 other We trail 17 other nations in life expectancy for males, 10 other nations in life expectancy for An American man of 40 has less chance of living to other controllable man-killers are higher in the U. S. than in at least 10 other industrial nations. The picture is even more distressing as it portrays the conditions of the poor in America. Poverty increases the risk of disease, disability and death. In 1968, the Blue Cross Association published a survey of health care in this country, conducted by the Louis Harris organization, which described the poor as "the living sick". And indeed, "living sick" is the prevailing condition of the impoverished in America today. The survey found that the poor place a high priority on trying to achieve a healthy status. For example, 59% of the poor blacks and 72% of the poor whites give health a higher priority than having a good job, compared with 51% of the American people as a whole. The poor recognize that good health is an essential precondition to achieving other valued goals. Illness and disease are unwelcome visitors to any home but to the poor they are a constant affliction. The poverty-poor health cycle means that the entire nation shares some of the burden of the inferior health of those afflicted by poverty. The poor suffer four times as many heart conditions as those in the highest income group; six times as much mental and nervous trouble; six times as much arthritis and rheumatism; six times as many cases of high blood pressure; over three times as many orthopedic impairments and almost eight times as many visual impairments. The incidence of disease by income group is shocking. In almost every category the rate of serious illness is reportedly two to three times higher for the poor than for the population as a whole. The rate of serious chronic illness seems to rise as one approaches poverty. Other statistics confirm the deprivation of nonwhite, disadvantaged Americans. In Detroit's "inner city", maternal deaths occur almost seven times as often as in Michigan, or the nation, as a whole. And on a national scale, the ratio of nonwhite to white mothers dying in childbirth was almost 3 to 1. The ratio of nonwhite to white babies dying in their first year was more than 2 to 1. The life expectancy of nonwhites is 7 years less than for the white American. 51-658 O-70-16 |