Prescription sought for perfect health care system

Nearly 43 million Americans are uninsured, despite a booming economy U.S. tops major countries in health care spending (1997 figures / per person) U.S. $4,090 (highest) Canada $2,095 France $2,051 29 OECD* countries: $1,747 (median) U.K. $1,347 (lowest) * Organization for Economic Cooperation and Development source: The Commonwealth Fund (details)  ALSO: Senate rejects patient lawsuit proposal

July 15, 1999
Web posted at: 2:30 p.m. EDT (1830 GMT)

In this story: Doctors' point of view Profit Vs nonprofit HMOs Money doesn't buy satisfaction Being creative to stay well RELATED STORIES, SITES

Schofield, a freelance paralegal, is one of 43 million uninsured Americans, a number that has grown by 11 percent in recent years despite the booming U.S. economy.

"I honestly live in fear," Schofield, 40, told CNN.

Currently doing legal work for a Long Island auto body shop, Schofield puts in a 60-hour week. She makes too much money to qualify for Medicaid coverage, but says her income is too small to make private health insurance affordable.

"I drive very carefully because I'm fearful of an accident," she said. "I try to eat well and take care of myself ... because I'm really afraid of getting sick."

Doctors' point of view

While Democrats and Republicans in Congress offer competing plans to help Schofield and all Americans with a "patient's bill of rights," Johnston, an emergency room doctor, is monitoring the portion of the debate dealing with HMOs and other managed care providers.

The California physician isn't happy about what, he says, profit-driven health care is doing to doctoring.

"The managed care companies are quite good at figuring out reasons why they shouldn't pay you," he told CNN. "We've already provided the services so we have no real recourse."

Dr. Francine Hanberg moved from emergency room work to private practice after her hospital's managed care company told her she could only spend 12 minutes with each patient.

"I asked, 'Why do you care? You don't pay me overtime. I keep no staff overtime.' And the answer I got was, 'If you do it again you will be fired,'" Hanberg told CNN.

Such stories are familiar to Dr. Randolph Smoak, president-elect of the American Medical Association.

"There are so many physicians who are so terribly frustrated who do not want to leave the profession but just feel like they cannot continue the way they are having to work under the constraints of managed care problems," Smoak told CNN.

Profit Vs nonprofit HMOs

Dr. Charles Shapiro, on the other hand, thinks the nonprofit, doctor-run HMO he works for is doing just fine.

Schofield says she lives in fear of becoming ill or being injured 718K/12 sec. AIFF or WAV sound)

"Not all HMOs are the same," the California urologist told CNN. "The group practice, nonprofit HMO really needs to be looked at differently from the general, generic class of HMO."

More than two-thirds of the nation's HMOs are for-profit, about three times the level in 1985.

A study, published this week in the Journal of the American Medical Association, found that the quality of care is higher in not-for-profit health maintenance organizations than in investor-owned health plans.

Calling "market medicine" a failed experiment, the investigators urge re-examination of a government-controlled national health insurance plan, an idea opposed by many in the health care industry.

"Even if I accept their flawed analysis, managed care still does twice as well as the fee-for-service health plans," said Susan Pisano, spokeswoman for the American Association of Health Plans, a trade group that represents both for profit and not-for-profit plans.

Money doesn't buy satisfaction

Some of those seeking to reform the U.S. health care system are looking across the border for solutions.

Hanberg says an HMO tried to control the number of minutes she spent with her patients 175K/17 sec. AIFF or WAV sound)

Canada provides universal care. Everyone is covered in what's called a "single payer" system. A government agency pays the bills not a private insurer.

"(The typical U.S. HMO) takes about 14 percent or 15 percent of every premium dollar for their overhead and profits. And the national health insurance system like Canada's runs for less than 1 percent of overhead," says Dr. David Himmelstein, a Harvard Medical School researcher.

Compared to other countries, the United States has more medical technology, more expensive hospitals and better paid doctors. Even so, health care is unevenly distributed.

"One of the ironies is that most of the other countries spend considerably less than we do on health care and many other countries have better track records on rates of mortality (and) infant mortality," says Marilyn Moon of the Urban Institute.

Money doesn't necessarily buy satisfaction, either.

A study by the Commonwealth Fund found 25 percent of Americans said they have difficulty getting health care when its needed. In Canada, where there are often long waits for elective surgery, it's 21 percent.

Of the 29 countries surveyed, Britain had the fewest complaints -- 15 percent -- as well as the lowest per capita spending on health care.

Being creative to stay well

Himmelstein says the U.S. health care system spends more money on overhead and profits than does Canada's system

While health care providers, employers and the public await whatever solution to the coverage crisis Washington will allow, the working poor, like Schofield, have to be creative to stay well.

A mother who worked her way off welfare, she doesn't want to land there again.

So for now, without insurance, she voluntarily participated in a university study on Lyme Disease, which she has. "I gave blood and spinal tap samples every 90 days just so I could get health care at no cost.

It's creativity she'd like to do without.

Correspondents Charles Bierbauer, Gary Tuchman and Greg LaMotte contributed to this report, written by Jim Morris