No “further dawdling” on US health care

William Holt (USA, AC 08-10)

 

Almost everyone is in agreement that something is ailing the American health care system, but no one seems quite sure what to do about it.  On one side of the debate, the left calls for the implementation of universal coverage styled after numerous examples in Europe.  Conversely, the right descries the public option as unfettered socialism (a screaming taboo for Americans) and insists that such a plan would infringe upon private insurers’ independence and thus upon the very nature of a free market economy.  Personally, I believe that the public option President Barack Obama has been espousing in town hall meetings across the country for the last few months is our only viable, sustainable solution.  Many of my compatriots would disagree.  The sound and fury that Mr. Obama has been met with have been edging toward anarchy–the reaction his policies have received has been, well, frightening.  Protesters have arrived at these meetings armed with shotguns, while congressman Joe Wilson ventured so far into insubordination as to denounce the President directly on the senate floor.  You would think, with all these accusations and mounting lawlessness, that we were living in the Wild West where problems would be solved by whomever shouted the loudest or carried the biggest gun. 

 

Mr. Obama has no doubt selected a difficult mission for himself, but the ire his policies face is nothing new.  Democrats have been pining for a national health insurance system since the days when Franklin Delano Roosevelt and Harry Truman had the presidency.  When such a proposal was first raised, it seemed the obvious direction to take after the installation of social security; unfortunately, much of its appeal was lost on Americans considering the leading exemplar in nationalized health care was then Nazi Germany.

 

What emerged instead was Blue Cross, which continues to be the foundation of the American system.  Blue Cross, however, is by no means sufficient enough to support the entire population, and its design is highly flawed.  It was intended to make money for hospitals and doctors; reliable insurance for the general public was not so high a priority, nor was good care.  Similarly, employer-based health insurance (now the most popular option) was instated only to placate a growing working class.

 

The gaps existing in the original system have since broadened.  In the past decade, 46 million Americans–15% of the population–were at one point without medical insurance.  And though some might dismiss this as a mere snapshot in time, the fact remains that tens of millions of people in this country are not insured, and those who do live in perennially high anxiety about having theirs revoked.  So many people have been locked into jobs simply because of the promise of coverage. 

 

Employer-based insurance by itself is damaging, driving up costs for hospitals, insurers, and patients alike.  But this is not to say that we must do away with it altogether.  To do so would be a grave mistake, as a total overhaul of any system poses too great a risk for us–it is simply impractical to have everyone leave their current plan.  Medicare needs only be used for those without any coverage at all.

 

It is important to note that health insurance is not the same thing as health care, and reform that focuses on the former while neglecting the latter is seriously–even lethally–misguided.  To be sure, Americans expect too much from their health care system.  Added to this is the fact that hospitals have a peculiar inability to admit their fallibility.  We have been pumping our system with money for so long that it has grown bloated and stodgy.  American doctors are paid three times more than those in France, and technological advancements in the profession have done nothing to alleviate costs.  Our system pays doctors and hospitals set fees for providing specific services, and it is to the advantage of their wallets to run patients through as much testing as possible.  These facts considered, we most not reform only insurance, but the way the money is spent.  In some cases, new technology has ameliorated the work of doctors and made it more efficient: the EMR (electronic medical record) has permanently replaced the paper chart, and is notable for its swift learning curve.  Other tests, however, are best performed manually.  With an expanding dependence on machinery, doctors are losing many of the most basic skills of their profession, those that would have been essential  in the days of house calls and have since been thought of as irrelevant.

 

But one cannot blame the system alone.  Its patients are just as guilty in effecting its decline.  We have fallen under the illusion that in order to receive good care, we must have a personal relationship with our doctor.  We have let ourselves be swayed by a ranking system based on reputation and availability of technology rather than quality of care.

 

One must also consider that our system is dangerously over-utilized.  We seek treatment when the answer is prevention.  The astronomical obesity rates in the United States (over 30% of adults) have caused a spike in heart disease and diabetes, leading to the overuse of medical resources and facilities when the solution is as simple as diet and exercise.  The current system is almost absurdly unbalanced.  While you would imagine that diabetes treatment would be of the utmost importance considering the numbers alone, it still lags far behind Europe’s.  On the other extreme, we have poured tremendous amounts of money into care for breast cancer, and have some of the finest facilities  in the world.  The system is marred by these oddities, gaping holes and over-concentrations.

               

The overhaul of the American health care system proposed by Mr. Obama is estimated to cost $100 billion per year.  Concern in the senate lies not in questions dealing with abortion or so-called death panels but the price tag.  This is in large part why so many Americans are reluctant to act, even when faced with something so egregiously wanting.  To make matters even more difficult is the fact that most Americans, by some innate, genetic deficiency, are averse to anything so much as resembling socialism (which a single-payer health care system would most certainly be).  Americans are not–nor ever have been–amenable to restrictions and regulation.  Many contend that a government-run insurance program would constitute a threat to private providers and patient autonomy.  It is important to note, however, that single-payer health insurance offers the best care at the lowest price.  And though it is unlikely that we will decide upon a public option anytime soon, it is at least something to strive for and can thus shape the bill that is eventually passed.

 

The highest priorities of any plan are to reduce waste and overspending.  Bearing this in mind, it becomes easy for Republicans and other critics of the public option to deride their Democratic counterparts as lavish spenders in a time that demands frugality.  The liberals’ goal of achieving universal health care within the year is unlikely to be realized.  Compromise will be the decisive factor, and so we would do best to steer the debate as far leftward as can be managed.

 

Perhaps the best working model of a compromised system we have to go on within our nation’s borders is the Massachusetts plan that was instated by former Republican Governor Mitt Romney.  In Massachusetts, health insurance is largely subsidized by tax payers, and those who are not covered by their employer or earn too much to qualify for Medicaid, are covered by this program.  As a nation, we must emulate this practice of handing vouchers only to those in need, and in order to effect a smooth transition from one system to another, we would do best to test a precedent set in several states across the country in which a Medicare experiment grants hospitals the  savings they generate from functioning more efficiently.

 

What will come of this debate is uncertain.  Perhaps the most disheartening factor to consider is that the topic of universal health care has been on the table for nearly seventy years and has shown no signs of moving closer to fruition.  Even so, the fact remains that the American health care system has been, since its inception, in bad decline.  The only solution is swift reform, without any further dawdling.

 

– United World College Student Magazine –

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