If I could have the time back that I’ve spent over the years refuting this notion, I’d spend it traveling the world.
I’d visit the many rich capitalistic nations whose citizens enjoy some form of state-supported, patient-centered health care: Finland, Israel, Taiwan, Japan, Germany, Canada, Switzerland, the United Kingdom, Sweden, France, and on and on. A fantastic trip, one that would include many of the world’s greatest nations.
In none other of these fellow "advanced" nations do citizens need worry about going bankrupt from unexpected medical bills, about changing jobs for fear of loss of health care coverage, or about going without needed care because of cost. In none other of these fellow democracies is the degree of health care received by citizens determined by the degree to which it can be minimized or denied solely to maximize insurance company profits.
When it comes to health care, the cruelties we accept other nations abhor.
As a pediatrician, often it is that I engage in conversations about health care with the parents of my patients. Several weeks ago I wrote about the growing numbers of uninsured in a diary that amazingly made the rec list. Health care, and the ungainly, unjust mess that is the American health care system, are thankfully issues of great importance here in Kosdom.
My intention today is not to rehash the injustices of our sick and dysfunctional system. My intention instead is to spark a discussion of how those of us supporting some concept of universal health care might bridge the yawning gap between ourselves and those opposing it.
My hope is to offer an on-the-ground perspective from the front lines of American health care, and to receive in response suggestions for how I and others might better persuade opponents of universal health care (UHC) to overcome their prejudices against it.
What follows are the talking points I’ve developed over years in primary care. My views here are my own, and they certainly open to criticism and correction by those more knowledgeable than I.
The "Socialized Medicine" Concern:
The familiar conservative bogeyman is "socialized medicine", and the title of this diary – or some variation – is the most familiar phrase uttered by opponents of UHC.
"Socialized medicine" is a perjorative term used primarily in the United States, and not elsewhere, by conservatives to refer to any form of government-run or regulated health care. It’s often combined with "European-style", or "Canadian-style", to associate it with publicly administered national health care systems in, well, just about every other modern nation in the world.
What’s interesting to me, and as I freely point out to conservatives, is that none of the soldiers in the war against "socialized medicine" ever calls for the abolition of the Veterans Affairs hospital and clinic system, or the military health care program (Tricare), or Medicare, or Medicaid, or the vast network of city, county, and state government run hospitals throughout the nation. The fact of the matter is that 45 cents of every health care dollar in the U.S. today comes, in one form or another, from the government.
What’s also interesting to me, and as I again freely point out, is that we don’t call other vital public services "socialized education", or "socialized fire departments", or "single payer law enforcement", or "socialized defense".
Opponents of UHC often express their worry that doctors and nurses will be in the employ of the state, and that health care will be run by bureaucrats, and that health care decisions will be taken out of the exam room and away from doctors and patients. I point out that this is not true in most any other modern nation with a national health system, and would not be true here under any proposed form of UHC presently on the table.
What is true, I go on to tell them, is that under our current system, which mandates insurer pre-approval for services, and which denies coverage and care to those with pre-existing conditions, decisions are being taken away from doctors and patients more than would ever occur under a national health care system.
Opponents of UHC also worry about rationing. What I tell them is that the U.S. rations care more harshly than any other country, by leaving the health of its citizens at the mercy of an expensive patchwork system where some get great care while others get none at all. Forty-seven million Americans, one-sixth of our population, have no health care and no protection against the financial impact of illness. Seventy million more are under-insured, having health insurance that barely covers their medical needs and leaves them unprepared to pay for major medical expenses.
Finally, opponents of UHC worry that nationalized health systems deliver inferior care. Again, not true. Study after international study finds that citizens in countries with national health systems are more likely than American citizens to have a regular doctor, to go to the doctor when ill, to be able to get an appointment within 48 hours, to fill and complete prescriptions, and to follow through on recommended tests, treatments, and follow-ups. If our "system" delivered such superior care, I tell them, why does the U.S. have one of the lowest life expectancies among modern nations? Something is just not right.
The "Increased Taxes" Concern:
For opponents of UHC, the worry over "increased taxes" is often at or near the front of their list of concerns. The only "universal" thing in which conservatives seem to believe is that all taxes are bad. Taxes are a burden that government must never increase, only lighten. And having universal health care would undoubtedly require increasing taxes.
My answer to this concern has always been to talk about "costs".
The costs of health care in this country are already staggering, and unless something changes, they will only get worse. As costs rise, fewer employers offer health insurance to their employees. As costs rise, more Americans become uninsured. Many millions already go without needed care because of cost. And when these millions seek care in the emergency room – as urged by their president – the cost of their delayed and now emergent and expensive care is passed on to the rest of us in the form of higher taxes and higher premiums.
Goods and services cost more because of employer-provided health care. Employers still offering health insurance are passing on ever more of their skyrocketing insurance costs to their employees, and are offering coverage less often to spouses and dependents of employees. Out-of-pocket medical costs now average more than $1000 annually over and above any contribution the employee makes to their insurance premiums. And employees are finding their health insurance plans covering fewer services, with higher co-pays and deductibles.
I mention to them the human costs, as well. The U.S. has one of the highest infant mortality rates, and highest rates of childhood death under age 5, in the developed world. We have one of the lowest life expectancies among developed nations. We have one of the lowest cancer survival rates. We are many times more likely to report going without care – seeing the doctor, filling a prescription, seeing the specialist, following-up – than are citizens in nations with national health systems. All this even though we are first in the world on spending per citizen on health care, by more than double the average of all other developed nations.
I also like to mention the "bureaucratic costs" of our current system. Conservatives dislike "bureaucracy", and are therefore taken aback when I point out that thirty-percent of health spending in the U.S. is spent on administrative costs, much of it squandered on mountains of red tape, on advertising and marketing, and on profits and executive pay of private insurance and drug companies. They are also taken aback when I mention that in all other rich capitalistic societies, each with some form of national health system, administrative ("bureaucratic") costs range from between two and eight percent. "Quite the difference, wouldn’t you say?" I ask them.
I then remind opponents of UHC that in our "free market" system, health insurance companies exist solely for the purpose of making money. Profit-run insurance does not and can not ever provide full care. Insurance companies maximize profit by authorizing as little care, and accepting as few sick patients, as possible. That is what all those administrative costs and mountains of paperwork are about: denying care. This is in fact the opposite of how the free-market generally works; namely, the more goods and services a company delivers, the greater its profits.
Finally, I wrap up by stating that while taxes would indeed rise with any form of national health system, costs would fall as preventive care was re-emphasized, delayed and catastrophic care became less common, drug costs were contained, administrative costs were brought under control, the costs to businesses large and small were stabilized, and the cruel costs of the very few making a profit on denying care to the very many were no longer.
The "Availability" Concern:
In the interest of not losing your interest, I will just briefly touch on this less commonly articulated, but nonetheless real concern of opponents of UHC.
On occasion, someone will tell me that while they support the idea of extending coverage to the uninsured, they worry that messing with they system to bring about universal coverage and health care for all might also hurt the availability of care that they themselves receive. "I have trouble getting an appointment with my doctor now – what’s going to happen when you flood the system with 47 million more people?" goes the common thought.
What I tell them is that while it is true that there are presently not enough primary care physicians in the U.S., any national health system that would be implemented (one would certainly hope) would take into account the need to encourage by financial incentive more medical students to enter into primary care medicine (pediatrics, family medicine, internal medicine). I also acknowledge that there may indeed be a difficult transition period while as a nation we re-emphasized primary and preventive care.
The Rigid Ideologue:
Finally, on occasion I encounter an ideological brick wall: the rigid, and often righteously religious, conservative. He or she proudly espouses the non-Biblical belief that "God helps those who help themselves." He or she believes that securing health care is a matter solely of individual responsibility, and that people do not have the moral right to have someone else pay for their health coverage – this only encourages dependence.
He or she believes that health care is a commodity that, like tires or televisions, should be bought and sold in the free market. If someone wants a commodity, they should work hard to afford it. If you do not have health insurance, it is your own fault. Lack of health insurance reveals lack of self-discipline, of personal responsibility. And if your children do not have health insurance, you have failed in your responsibility as a parent.
There is only so much I can do to respond to the rigid ideologue. So what I ask them is "Was not Jesus a healer of the sick? Did not Jesus seek to ease suffering and health disease, no matter how it came to afflict those who suffer? If we are indeed created in the image of God, and if all life is precious, then is it not a violation of God’s intended dignity that so many of our sisters and brothers lack access to basic health care? Are not Christians urged to love their neighbors as themselves?" The answer usually involves some hemming and hawing.
Thanks for reading.