Our present fee-for-service health care system is by far the world’s most expensive, twice that of second-place France. It is also an inflexible, bureaucratic, antiquated system used by no other industrialized nation today, and for good reason.

Due to our comparatively low life expectancy and high infant mortality rates, the embarrassingly high number of people without insurance, high response times and long waiting times for elective surgery, the U.S. health care system is rated 36th on the world scale by the World Health Organization. This is just below Costa Rica.

Our private health insurance charges are also the world’s highest, partly due to unnecessarily high administrative costs spent on trying to shift legitimate charges elsewhere or to avoid them altogether. Another major contributor is the world’s highest medical personnel salaries of doctors, nurses and technicians. But for these high charges we, the world’s wealthiest, most powerful nation, get minimally acceptable service. Then who has the best health care?

In some years France’s health care has been rated the best. Their set-up is a rather complex mixture of public and private health care services and insurance. But it is rated quite highly in responsiveness, coverage and overall quality. And the Scandinavian systems, particularly Norway’s, are also rated highly. But many American observers feel the Canadian single-payer, multiple-provider model would best suit our economy, culture and lifestyle.

During a 1993 two-week vacation in western Canada I heard few negative comments on their health care. The biggest complaint seemed to be on long waiting times for elective surgery, a frustration I have encountered several times in the Chattanooga area. In Canada they say the favorite indoor sport, after ice hockey, of course, is complaining about their health care and bragging on it.

But how will we pay for it? Hey folks! We are already paying for it, and in the most expensive way. People are rarely denied care due to their inability to pay. Indigents know they can go to the emergency room of any public hospital and be treated. I have personally seen people at the Erlanger ER with a tooth ache. But the emergency room is the most expensive way to provide treatment. And hospitals don’t absorb or “eat” these costs either, they pass them on to “guess who?” A well-conceived network of county clinics could provide more efficient and less costly treatment to those unable to pay. And the prices of our health insurance have substantially increased, of course, in line with the alarming rise in treatment costs.

The biggest savings would obviously be in eliminating much of our unnecessary, duplicative administrative procedures. Today we must often fill out page after page of repetitive information on an unwieldy clipboard in uncomfortable chairs while being assured all this bureaucratic nonsense is entirely necessary each time we visit the doctor’s office. With a restricted-access centralized medical records system much of this unnecessary mess could be streamlined or eliminated. One Canadian told me, “We simply go to the provider, receive the needed care/treatment, sign for it and that’s it.”

Our skyrocketing cost of health care is simply unsustainable from both a personal and macro-economic viewpoint. But what are we doing about it?

George B. Reed Jr., who lives in Rossville, can be reached by email at reed1600@bellsouth.net.

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