Dr. Rosenfeld is the Health Editor of Parade Magazine and author of "Breakthrough Health 2004." In this August 15, 2004 article, he writes: "Every American must have access to all the benefits modern medicine can provide."

He describes the "plight of 44 million Americans (one in seven) with little or no access to medical care because they have no health insurance…" and goes on to state: "These are not only the poor. A third of them earn at least $50,000 but still cannot afford the rising cost of health insurance premiums and at the same time support their families and educate their children."

The cause of the problem, Dr. Rosenfeld states, is that "health care costs have skyrocketed because of the great advances in medicine. Progress has been expensive due to all the new sophisticated tests and procedures: MRIs, CT and PET scans and the costly breakthroughs in treating cancer, heart disease and infection." In addition, he cites the fact that we’re living longer, and therefore prone to suffer from chronic diseases, giving rise to more medications, doctor visits etc.

He mentions employers having to cut back on the cost of health insurance for employees because they have to compete in a global market place. But he fails to point out that the United States is the only country in the world where employers are expected to provide health insurance, and therefore American companies are at an economic disadvantage when competing with foreign businesses – whose workers receive coverage through universal health insurance programs financed by income taxes.

Dr. Rosenfeld concludes by "suggesting":

• "First and foremost, we must guarantee access to medical care for every man, woman, and child. We are the only industrialized nation that does not do so.
• "Second, we must reduce the current large malpractice insurance costs that are forcing doctors out of "high risk" specialties and leaving many smaller communities unprotected. Any solution, however, must compensate realistically those who have been hurt by "bad medicine."
• "Finally, every patient must receive whatever medications he or she needs in order to enjoy good health."

We most certainly agree with Dr. Rosenfeld’s first suggestion. However, we think that the malpractice insurance issue, while an important problem in need of reform, is a minor factor contributing to the problem of health care costs. In fact, we suggest that Dr. Rosenfeld has overlooked the principal causes of the skyrocketing cost of health care, and failed to state the obvious, logical conclusion.

True, the great advances in medicine result in increased costs. However, these advances are also available to patients in Britain, Canada, Germany, Japan, New Zealand and in every other industrialized nation.

The difference is that we have to pay more than twice as much as patients in those countries pay to enjoy the benefit of these same great advances, and one American in seven has no access to health care or receives "third world" care.

True, we are living longer, and are more prone to chronic diseases. However, in nearly every other western nation, people live longer than we do, and enjoy healthier lives where health care is accessible to all. How, then, is it that we pay more than twice as much for a health care system that does not deliver, a health care system that fails to ensure quality of care, and that leaves 44 million unprotected (or 55 million, or 66 million, if uninsured people are counted the way unemployed people are counted)? The answer is not written in the wind. The answer is written in the Wall Street Journal.

Much of the health care dollar winds up as the bottom line of annual reports of insurance companies, hospital chains and drug manufacturers. Let’s look at some estimates (and they are only estimates, since believable figures are hard to come by) of where our health care dollar goes.

One estimate is that 40 cents of every health care dollar goes to pay for public programs – Medicare, Medicaid, Veterans’ Services, military medicine, the Public Health Service, the Centers for Disease Control, Congressional coverage etc. The other 60 cents go to the private sector, including administrative expense and profits of HMOs, insurance companies, drug manufacturers, hospital chains, durable goods manufacturers, physician groups, advertisers and lobbyists. It includes premiums from non-government covered HMO members, hospitals’ private patients, doctors’ non-government income, prescription drugs that are not paid for by public programs, and health insurance premiums.

Another estimate is that the 40 cents in the public programs deliver health care with a 3% administrative cost and no profit, while the 60 cents in the private sector have an overhead of 30% to 40%, not counting profits! This translates to almost 39 cents of health care in the public sector (1.2 cents overhead) and somewhat less than 36 to 42 cents worth in the private sector, 18 to 24 cents for overhead and waste, with, say, a 5% profit margin, leaving between 31 and 37 cents of the 60 cents for health care. So government programs don’t work?

This rough estimate accounts for about half of the discrepancy between the cost of health care in the United States and health care in other industrialized nations. The rest of the discrepancy is most likely due to unnecessary surgeries, ineffective treatments, lack of continuity of care that results when millions receive only episodic care in emergency rooms and clinics, preventable disability, lack of preventive and rehabilitative services, avoidable wound infections, lack of immunizations, and the greater costs of treating injuries and disease when they reach an acute stage, when timely intervention would have been much less costly, and, yes, "defensive" medicine, malpractice judgements and premiums.

Dr. Rosenfeld, can’t you see that we can only fix health care with a universal health insurance program? (Ed.)

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