A panel of experts discussed the state of healthcare in America and critiqued the nation's primary healthcare solutions Thursday evening. The discussion examined the issues of rising costs, uninsured persons, and the plans that have been proposed to minimize these problems.
Dr. Gilbert Welch discussed the steady rise in healthcare costs since the 1960s. Expanded federal entitlements have combined with the rising costs of drugs to increase healthcare costs as a percentage of GDP from roughly six percent during the '60s to roughly 15 percent in 2003. Welch cited inefficient administration of government programs and drug company promotion of non-generic drugs as key contributing factors. Dr. Amitabh Chandra and Welch agreed that physicians also inflate healthcare costs by under-prescribing less-expensive generic drugs.
Chandra argued that increased expenditures on health care do not necessarily translate into better care. He presented data that illustrated a general inverse relationship between the amount of money per capita that a state spends on healthcare and the quality of care that patients receive. Dr. Elliott Fisher presented similar data and endorsed Chandra's conclusions about the unnecessarily high costs of current healthcare mechanisms.
The problem of uninsured Americans received extensive attention. According to the panel, 15 percent of Americans have no health insurance. The group of uninsured persons is composed primarily of employed young minority adults with a low level of education.
Chandra dismissed the single-payer national healthcare model as excessively expensive and potentially inefficient. This system would provide blanket coverage of all American citizens and would be financed by a progressive income tax.
Chandra argued that such a program would require a dramatic 12 percent increase in income taxes. Chandra stated that a national healthcare program would lead to over-prescription of expensive drugs and potentially higher unemployment rates. He also stated that several countries that have implemented national healthcare programs have reduced physicians' incomes in order to manage costs. Chandra believes that the quality of care has declined as physicians' earnings have suffered.
The panel was less critical of alternatives to the national healthcare system. Chandra, whose presentation was the primary focus of the panel discussion, said that individual mandate plans, plans to expand Medicare, plans to expand Medicaid and federal tax credits for healthcare are positive steps.
Individual mandate programs would require citizens to buy healthcare if they don't have it. At the moment, many of the uninsured persons do not have healthcare because they are young, healthy and do not feel a need to have coverage. In the event that a person could not afford to buy healthcare, tax credits of equal value could be provided.
Plans to expand Medicaid and Medicare received the panel's endorsement. Plans to expand Medicaid would effectively cover all children into early adulthood. Plans to expand Medicare would allow older adults who are not quite eligible for Medicare to buy into the system early.
However, Chandra warned that expansion of Medicaid to cover young adults could result in employers dropping benefits to young people who had already received coverage through their jobs.
Companies could see the new program as an opportunity to unload their displace their burden onto the government. The result could be that entitlements designed to relieve a minority of uninsured persons could suddenly apply to a majority of formerly ensured workers.
Chandra spoke most favorably about proposed tax credits for health insurance. He said that credits will place the least burden on government finances, reduce the risk of excessive demand that national healthcare poses, and will prevent employers from reducing wages in order to cover healthcare costs.
The discussion, which was held in Kellogg Auditorium, was well attended. Over 60 students, faculty and community members were present.
