Three prominent health-care experts weigh in on reform at a physician forum in San Jose

One of the best ways to help the growing number of uninsured people in the United States is through a federal voucher system that gives people the freedom to purchase their own medical insurance.
That’s the opinion of three prominent scholars of health-care reform who spoke before a crowd of physicians at Good Samaritan Hospital in San Jose. The Santa Clara County Medical Association sponsored the March forum.

The speakers included Dr. Philip Lee, a Stanford professor who served President Lyndon Johnson as Assistant Secretary for Health and Scientific Affairs, Dr. Samuel Sessions, professor of health law at the UCLA, and Sally Pipes, CEO of Pacific Research Institute in San Francisco.

“The employer-based health insurance system in this country is gradually disappearing,” said Dr. Lee. “And a federal voucher system could be the answer.”

About 15 percent of the U.S. population — or 47 million people — are uninsured. That’s up from 39 million in 2000. The problem stems from escalating medical costs that drive insurance premiums up, making it less affordable for employers.

In 1977, about 70 percent of the working population had employer-sponsored medical insurance, compared with 59 percent in 2006, according to the Kaiser Family Foundation. This is a disturbing downward trend that’s likely to continue.

Legislators in Sacramento have proposed a variety of health care reform plans, but experts say this can’t be resolved at the state level because nearly half of health care dollars come from the federal government in the form of Medicare, Medicaid and other programs for the uninsured.

The only solution to this growing problem is universal health care. Such a system could be implemented in a variety of ways, and the forum’s three speakers believe the voucher system would be ideal.

Any proposed change has to be accompanied with a political strategy that will convince Congress and the American public to accept the reform. Dr. Lee said a variety of reform attempts have failed because they were too complicated and there was no political strategy to escort them through the process.

Health-care reform has to fit within the American value system of choice and flexibility, said Dr. Lee, who hopes to publish a peer-reviewed paper with Dr. Sessions about health-care reform. A voucher system will provide choice.

The proposed voucher system would be expensive, and take a decade to implement. The $2 trillion health-care industry is far too large for overnight change, said Dr. Sessions.

A voucher system could cost an estimated $1 trillion a year to provide basic coverage for all Americans. The costs would be paid with a value-added tax system, which basically taxes products as they move through distribution channels. For example, flour would be taxed when sold to a bakery, and the bakery’s muffin would be taxed when sold to the consumer.

“This is a fair system,” said Dr. Sessions. In a value-added system, unlike payroll taxes, and estate taxes, everyone in the United States pays. There would be fewer ways to avoid taxes for anyone, even if the person isn’t in the country legally.

The voucher would give people the option to purchase a basic health plan, and also the freedom to purchase an upgraded plan on their own. Such a system would maintain a level of choice, and sustain the current competitive nature in the health care industry, which is the bedrock of our culture, Dr. Sessions said. Employers could offer upgrades to the basic insurance.

Americans have a fear of the government taking over the health-care system, often quoting the many issues other countries have with socialized medicine – such as long waits for surgery or diagnostic services. But in reality, the government already pays for about 60 percent of the medical care in this country between Medicare, Medicaid and a variety of special programs, said Dr. Sessions.

Since the cost of medical care continues to outpace inflation, health-care reform is inevitable. But it’s going to take a congressperson with a lot of courage and charisma to ensure real reform without special interest influence, said Dr. Lee.

“You want to raise the temperature slowly,” said Pipes. The goal is to ease the American public into a new form of medical coverage.

Pipes, a Canadian, wrote the book “Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer.”

“Health care is similar to peeling an onion. There are many tearful moments,” she said.

Troy May is the editor of Bay Area Oncology News. You can reach him at tmay@BaOncologyNews.com.

—By Troy May

Posted on April 23, 2007 11:30 AM