Universal health care

I’ve been reading a bit to bring myself up to speed on the health care controversy. The best book I’ve read so far is T. R. Reid’s The Healing of America (thank you, Upper Hudson Library Federation, for free access to the e-book version). I should have taken notes, but here are the major take-aways:
1. To have universal health care, a nation needs to want it. The deep rift over “Obamacare” reveals we are not there yet as a nation, even though 22,000 people a year die, and 700,000 go bankrupt, solely because of lack of health insurance in our country. Many people falsely believe that anyone can receive free care for virtually any ailment in hospital emergency rooms; even if true (which it is not), that would be terribly wasteful and less effective than appropriate care venues.

2.  In order to insure everyone, everyone needs to be insured.  The healthy and young will pay in until they become unhealthy, when the system starts to pay out; by then, new healthy insureds should keep the system in balance.

3.  Covering everyone does not mean covering everything.  There will have to be some rationing — for example, hip surgery may not be authorized for someone 90 years old who has other health problems.  The body that makes these decisions must have credibility, impartiality and transparency, or people will lose confidence in the system.

4.  Non profit payers are required to reduce overhead and eliminate the bureaucracy established for the purpose of denying coverage and claims.

5.  A central power – either a single payer or a government body that sets uniform rates for all payers – is necessary to bargain effectively with providers.  What Reid does not state explicitly is that doctors and other providers should be prepared to work for less under such a system.

Citizens of the US harbor many misconceptions about universal health care, in addition to the belief that a minimal level of care already is available to everyone:

1.  Universal health care requires “socialization” of medicine, with the government owning the facilities and employing the providers. While government ownership is one model, other countries that provide superior care to all their citizens for less cost than we do use private doctors and facilities, and give citizens broad choice of provider and (non-profit) insurer.  

2.  Government cannot run health care as well as the for-profit private sector.  Medicare is one of the largest, most popular and most efficient government programs, and its administrative overhead is far lower than our private health care sector, though it serves a higher need population.  Our system of veterans hospitals is an example of pure socialized medicine, where the government employs the providers and owns the facilities, and where consumers are not billed for the services they receive.

There are many ways to skin the cat, if we have the collective will to extend health care to everyone and resist the special interests in favor of the status quo.  Obamacare may not be the ideal solution, but it’s a step in the right direction, and long over due.

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