The article by Himmelstein et al1 in this issue of the The American Journal of Medicine documents that health care expenses were the most common cause of bankruptcy in the United States in 2007, accounting for 62% of US bankruptcies compared with 8% in 1981.
Most bankruptcies occurred in middle-class citizens with health insurance, further evidence that our current health care system, based on for-profit, employment-based health insurance, is not working. Millions of Americans have limited access to health care because they cannot afford health insurance. Millions of others, such as those who have to file for bankruptcy because of health care costs, have inadequate health insurance. It is estimated that 1 in 5 Americans goes without health insurance or has inadequate health insurance.3
Why is the United States, one of the richest countries in the world, the only major industrial nation that is unable to provide access to health care to all its citizens? Are there any other nations whose citizens have to declare bankruptcy because of health care expenses?
Other industrial nations ensure access to health care to all their citizens, at a much lower cost than the United States, and with better health outcomes, by 1 of 2 basic plans.
In some nations, such as the United Kingdom, the government provides health care and pays for it from general taxation. The government employs the physicians and other health care workers and owns and operates the hospitals. The US Veterans Health Care and Indian Health Service are examples of this model.
Other nations ensure access to health care by requiring all its citizens to have health insurance. The insurance premiums are paid by the citizen, and in most cases the employer shares the premium.
The insurance is provided by nonprofit companies, supervised by the federal government. Unlike in the United Kingdom, the health care is delivered by the private sector: private doctors and private hospitals. US Medicare is an example of this system of providing health care. Medicare has been providing excellent health care to our senior citizens for more than 40 years with an administrative overhead in the range of 2%.4 Nearly all US physicians and hospitals participate in Medicare. US Medicare is not socialized medicine. Health care is delivered by the private sector; patients have their choice of physicians and hospitals. There is no rationing, and there are no waiting lists.
Have any US Medicare patients had to file bankruptcy because of health care costs? Why not Medicare for all Americans? It has worked very well for more than 40 years.5
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