In either case, there will be a significant number of people who still can’t afford the care that would enable them to survive a life threatening illness or accident. The $2,500 savings or tax credit is small change in a world where $300,000 hospital bills and $1,500 a month drug expenses are possible. Although $2,500 might cover a portion of the cost of threadbare insurance plans, it would not cover the bills incurred by chronically ill patients who need to fill five or six prescriptions for expensive drugs every month, or save the lives of those whose insurance “runs out” during an extended illness.
One obstacle to arriving at a humane and efficient universal coverage solution is that Americans remain divided about whether all citizens deserve health care, regardless of their level of economic productivity. We lack solidarity. If we really believed “it’s our willingness to be our brothers’ keepers that in part defines who we are as Americans,” as Michael L. Millenson claims in “Want Universal Health Care? The Operative ‘Word Is ‘Care’” we would have taken decisive action long ago.
Millenson admits that fewer and fewer physicians are willing to accept Medicaid and uninsured patients. One might be tempted to denounce prosperous physicians for their inflated charges and for shunning the uninsured. But it’s likely that many doctors care; they simply can’t afford to accept the comparatively small reimbursement, considering their enormous overhead and escalating malpractice premiums. Physicians who escape that quicksand scenario by practicing within the confines of managed care must sacrifice autonomy. The current system has betrayed both doctors and patients.
In response to a New York Times editorial suggesting that Medicare be expanded to replace private insurance companies, Arnold S. Relman, M.D. writes that nothing short of “salaried physicians working in prepaid medical groups” will stem the rising cost of medical care. This professor emeritus of medicine and social medicine at Harvard Medical School explains that Medicare’s costs have kept pace with escalating private sector costs because “economic incentives encourage overuse of expensive medical technology even when it is of unproven or marginal benefit.”
Through the lens of the socialism-fearing economists writing for Capitalism Magazine, universal health care is a euphemism for socialized medicine, with its accompanying evils: poor service, bureaucratic waste, erosion of physician autonomy, and elimination of patient choice. But how can that be the case when universal care providers would not be on the government payroll, but have a fee-for-service practice? The Case for Universal Health Care in the United States explains that “it is a health care payment system, not a health care delivery system.”
It’s true that patients in Canada and other universal systems have had to put up with longer waits for appointments and have endured other restrictions that Americans would find onerous. However, they are in the process of implementing the needed reforms, and by studying their systems America could learn how to avoid some of the initial problems. In a presentation at the 2007 World Health Congress in Barcelona, Spain, David Nicholson, the chief executive of Britain’s patient centered National Health Service, explained how the UK has increased its per capita healthcare spending by 11 percent between 2002 and 2008, resulting in dramatically decreased wait times and a significant decrease in mortality rates for major diseases. Not only have patient care and outcomes improved, the system expects a surplus of £13m. Patients continue to report “high levels of satisfaction.”
Nicholson reported that the UK is also implementing information technology that improves patient care and encourages patients to assume more personal responsibility in managing their health. British patients are scheduling appointments online and receiving prescriptions electronically. Doctors have e-access to patients’ x-rays, enabling them to diagnose life-threatening conditions and intervene from a distance. Eventually, patients, as well as their doctors, will be able to view their medical records online in interactive formats tailored to the needs of each.
We have a long way to go.
America remains the only industrialized nation without universal coverage for its citizens. We proudly spend considerably more—at least 40 percent more per capita—than nations with universal access to care, only to achieve markedly poorer performance. And we obtain this sorry outcome despite the outstanding education of our health care professionals and our superior medical infrastructure. Even those who lack fellow-feeling for the non-insured and under-insured might feel a twinge of shame about that.
Silke Fauve teaches college English and promotes critical thinking about transhumanist issues, as a World Transhumanist Association activist.