The Costs and Complications of Universal Health

Perhaps we should begin instead with a universal preventive system  

by Janice Van Cleve 

Michael Moore does not live in a gray area. Critics and the film-watching public either love him or hate him. And that’s the way he likes it. His movies do not pretend to be balanced or fair. He’s out to make a point and drive it home. So it is no surprise that his 2007 film Sicko, is still drawing praise and anger. ìSickoî takes on the American health care system with all the delicacy of a lumberjack.

President Obama doesn’t have that luxury. He can’t just highlight the flaws—he has to win support for a solution. That’s why in June he addressed the American Medical Association in Chicago. He drew lots of praise, but now the difficult questions begin about how to design a universal—or even a fairly comprehensive—system.  

1. Who to cover

Universal health care advocates say everybody should be covered. However, throwing open the doors—and the treasury—to everyone for health care is burdening even the most experienced and sophisticated European health care systems right now. Sweden, Germany and France have been at this for awhile and even with income taxes above 50% they are barely paying for it.

Anyone designing a healthcare system has to make some judgments about who to include and when to include them.

For example, should an undocumented alien be able to tap into a universal health care system just like a citizen? What about self abusers? Smokers? People who work in hazardous occupations? Should universal care be based on judgments about a person’s work or lifestyle? What about rich people? Should they also be eligible for ìuniversalî health care or should it only be available to those of lower income?

What about the very young and very old? Modern medicine goes to extreme lengths to salvage barely viable premature births and it devotes even more effort and expense to extend the lives of barely viable elderly patients. In fact it is estimated that most medical expenses are incurred in the last two years of the average person’s life.  

2. Treatable illnesses

It’s easy to justify offering universal vaccinations free of charge against contagious diseases. Other sorts of conditions might be debatable. For example, what about sexually transmitted diseases? What about pregnancies, fertililty treatment, birth control and abortion? Plastic surgery? Sexual reassignments? Life support for people in vegetative states?  

3. Drugs

The Bush administration cobbled together a complicated bill that benefited no one except the pharmaceutical industry. Seniors are penalized for not joining it and officials are forbidden to negotiate for lower prices. What drugs should be included in a universal health care formulary? Anything a doctor prescribes, or only generic drugs? Should Viagra, hormones, anti-depressants, and pain killers be paid for by the public?

In the case of vaccinable illness, should people be forced against their will to get inoculated? Should universal health care ever be mandatory? These questions lead to very basic ethical dilemmas that—if not considered—will cripple any system that tries to be 100% universal. 

4. Providers

Certainly the American Medical Association and the American Psychiatric Association would promote their members as the primary health care givers under a universal system. We can count on the American Dental Association to jump in, too.

But what about alternative medical providers, massage therapists, hospice nurses, home health care providers, or fire department medics? We don’t even license some of these caregivers. 

5. Legal costs

Lawsuits drive a major portion of the inflation in health care costs. Some states have made progress in the latter area with so-called ìGood Samaritan Lawsî which shield ordinary people from liability when they help out in emergencies, but much more needs to be done to protect health care providers from lawsuits. 

6. Funding

Then comes the big question: how is universal health care supposed to be funded? Should universal health care be a federal program or should it be up to the states? Should basic costs be shouldered by employers? Should tax incentives be involved? Should there be any financial limits on how much should be spent for any one person?

And what role should private insurance play? Currently, the health of many Americans is in the hands of for-profit corporations. With co-pays, deductibles, non-allowances, exclusions, prior conditions, denials, and the like, customers are once again bearing many the costs individually while the insurance company or HMO focuses on investments and stock options. Underwriters and accountants are making decisions that only medical professionals and patients should make. 

7. Leadership

Congress is obviously front and center in fixing America’s health care system, but look what they did to the prescription drug benefit. They cowed to the pharmaceutical corporations and specifically disallowed negotiating for lower prices. President Reagan politicized health care by simply ignoring AIDS in the 1980’s when it was ravaging the gay community. Can the US government really be trusted to fix the American health care system? And who will decide the ongoing issues once any system is set in place by Congress? 

Until Americans can answer these questions, there will be no universal health care system in the United States. Politicians can stump and promise but their speeches are just so much hot air blowing in the wind. Perhaps it would be more realistic to approach health in America from a less grandiose place than ìuniversal health care.î Perhaps starting with a few basics at the grass roots would be more reasonable and more achievable. 

A first step: preventive care

A better, simpler, and cheaper route to universal care would be a government-funded system of preventive care, with free annual physical exams and relevant testing, regardless of citizenship. It could include free annual dental exams and teeth cleaning, as well as eye exams. Just this alone would make a huge difference in the health of all Americans. It would: 

1. Provide the basic necessary first step to any health care program.

2. Provide everybody access to a doctor and a dentist for basic care, to talk about health concerns, to find out what’s wrong, if anything, and to receive advice for healthier living choices.

3. Make possible a genuine assessment of the nation’s health.

4. Alert patients and doctors to health concerns early when they are still curable instead of waiting until they are an unavoidable and much more expensive emergency.

5. Reduce insurance costs for care by providing preventative screening early and free up front.

6. Be understandable and acceptable to all Americans.

7. Be a good start. 

The next step up would be free immunizations and free prescription drugs. Providing prescription drugs is not a one size fits all proposition. New drugs are coming on the market all the time and each patient’s condition and tolerance is different. Pharmaceutical corporations are constantly advertising to the public and promoting to doctors to push their individual products. Michael Moore claims that there are four pill lobbyists for every member of Congress!

President Obama still faces the fear mongers who warn of the so-called ìdangersî of socialized medicine. They claim that the free market is the best way to deliver health, the same free market that delivered Enron, Worldcom, Wall Street banks, Washington Mutual, AIG, General Motors, Chrysler, etc.  But that’s not the point. The real point is that health is a basic human right that should never be patented or sold. It should be provided like the preamble of the Constitution says: ìto establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity.î

A grand universal health care system may not be achievable in the United States anytime soon, but a universal preventive care system along the lines suggested here would go a long way toward improving the health of all Americans, which could be a first step.

And then maybe the United States could reach a higher health care rating than Slovenia. 

Janice Van Cleve had to pay over $700 for her physical exam, despite being completely healthy. She supposedly has one of the better individual health insurance plans in WA. Copyright 2009.