There is widespread agreement that today’s healthcare system in the United States is ineffective and problem-ridden. From having somewhere near one fifth of U.S. citizens living with no health insurance (link), to hospitals closing in the poorest areas (link), to massive amounts of medical fraud (link), extremely high costs of qualifying new treatments (link), and ever-expanding drug company profits (link). It is interesting that the worst health system problems seem to be in the richest free-market economy in the world. Is this an indication that when a medical system is comprised mostly of privately held, for-profit corporations it is incapable, systemically, of serving the average citizen as might be expected? While some countries with universal health care systems of one type or another also report problems, I have to wonder if any of them approach the incredibly complicated, ever-worsening U.S. health care system.
Repeated complaints by some that, in countries with universal health care, long patient waiting times, free choice of service providers, etc. show that universal health care can not work have not convinced me. These sorts of complaints strike me like those of a woman I spoke with in Milan, Italy as my wife and I traveled with great ease and speed around the country by train. The woman remarked to us that “the trains here are just terrible. Sometimes they are ten or even twenty minutes late.” I almost broke out laughing, and pointed out to her that, where we live, you are lucky to find a passenger train, and if you do, it is old, very slow, always late, and has to slow down to walking speed on some curves because the tracks are in such bad condition. I have to think that, similarly, negative comments about foreign health systems may often be based on individual experience and perspective.
Many countries in the world already have universal health care systems, based on a variety of approaches, and with a variety of outcomes (link). Is it the more complex and partially private systems such as that in Canada that have the most problems? I have suggested in previous items in this blog that, in the future, it is quite possible that health care will have to be supplied on the same basis as military protection. I also believe that the government should be directly carrying out important health research rather than leaving it to occur only where it provides a private organization with profit potential.
It becomes increasingly clear that a sustainable world will include good universal health care systems, and that such systems will rest on some clear principles. Among those that seem common to or are proposed for the most successful systems are:
1. Mandatory coverage is provided for all. Everyone is eligible for treatment. Discrimination is prohibited, including any based on pre-existing or current medical condition.
2. A minimum level of coverage is provided for all.
3. If private insurance is involved, “cream skimming” by selectively insuring only more profitable groups is be prohibited. (Note that Germany allows for private coverage only as an option based on having a high income. I do not believe the option exempts anyone from general taxation to cover medical systems.)
4. Preventative and primary care are emphasized and effectively supported. Health costs are best controlled by prevention and early intervention.
5. Patient can choose their health service provider.
6. Health care coverage is portable, providing coverage when away from home.
7. A balanced health information system exists in which privacy is protected and appropriate access to patient information is provided to medical professionals as needed.
8. Systems exist for peer review, second opinions, appeals to independent arbitrating bodies, and reasonable compensation to patients wronged.
10. Government sponsors or conducts research into low cost (low profit) remedies and treatments for medical problems afflicting smaller numbers of people.
11. Government ensures, by funding and other means, adequate training and research institutions to provide a stream of educated medical professionals and medical advances.
12. Government provides for full catastrophic, palliative, and end-of-life care.
13. Systems enable public input to all planning and regulatory processes.
Certainly it seems that, as opposed to gnawing away at the health care situation as we are now, trying to preserve private profits and incentive to research at the expense of those who are suffering without adequate coverage, for example, we should be working towards a vision of an optimal future situation. If we take the long term view (which we will need to in order to achieve sustainability), design a system that can achieve the best principles of universal health care, “cherrypicking” from the best existing systems in the world and creatively finding ways to do even better, and then set up a master plan to guide changes in our legislative and governmental systems to achieve that design by an established future date, such as 2028, I believe we can succeed. This will require visionary leadership at the highest level and collaboration on a very broad scale, but it must be done if we are to achieve the future we desire.
As always, your constructive comments are welcome.
Among the sources consulted for this entry are:
American Medical Student Association report,
National Academy of Science press release,
The Ljubljana Charter on Reforming Health Care, 1996, World Health Organization,
Wikipedia article on universal health care,
Speech by Ulla Schmidt, German Federal Minister of Health