More care, less money. Rhode Islanders already spend enough on health care to afford comprehensive health care for everyone, according to a recent study by School of Public Health Professor Alan Sager and Deborah Socolar, a project manager in the SPH department of health services, both of the SPH Health Reform Program. The report, funded with a legislative grant from the Rhode Island General Assembly, concludes that the state, with health-care spending 21.5 percent above the national average, could have provided health care for all its citizens -- and saved 0 million -- if it had enacted reforms this year.

By moving to consolidated health-care financing, the authors estimate, at least 0 million could be saved in administrative expenses alone -- more than 10 percent of total health spending. Less money spent on billing and claims processing would mean more money for actual health care for all Rhode Island residents. An additional 8 million in savings could be realized through more appropriate use of hospital and physician care, bulk purchasing, and negotiated price cuts for prescription drugs and medical equipment.

The authors suggest two possible plans. Both eliminate private insurance and out-of-pocket payments (such as co-pays and benefit caps). They provide coverage to those with no health insurance and extend coverage for those who are presently underinsured, including coverage for dental care, prescription drugs, and home health care.

The first plan, a simple single-payer approach, raises funds by increasing taxes. The second plan puts all the money now paid by employers and employees to private health insurers into a common pool along with current public funding to cover all health costs.

The report estimates the costs of universal health care and contrasts it with a continuation of the current system. It points out that “ever-higher spending for business as usual in Rhode Island health care is not sustainable for people who pay for it, or for people who use it . . .[and] is cheating the state’s people by wasting huge sums on the private sector’s payment bureaucracy at the expense of the care that all Rhode Islanders need.”

It is much more feasible to try new approaches at the state level, say the authors, since states are so different in political temperament, resources, and needs. A new system in Rhode Island would require adjustments in federal programs --such as Medicaid and Medicare -- a prospect that recently became more likely. Early in December the Boston Globe reported that according to the National Academy of Sciences, “The health-care delivery system is incapable of meeting the present, let alone the future, needs of the American public.” The academy recommended that the federal government allow states to experiment with different schemes for achieving universal coverage, a message, said the Globe article, “the Bush administration said it would take to heart.”

The BU researchers collaborated with consultants at Solutions for Progress in Philadelphia. The team had previously analyzed the cost of universal health care in Massachusetts. Their November 2000 report on that study is available on the Health Reform Program Web site at http://www.healthreformprogram.org . The Rhode Island study can be read at http://dcc2.bumc.bu.edu/hs/ushealthreform.htm.