Do We Really Want Universal Health Care?

By Charles Pesson, MD

There is no question that there are serious problems with our current healthcare system. Costs are high and many are left without insurance. Many Americans must depend on free treatment at emergency rooms and community hospitals to get by. The current economic environment has deprived more and more Americans of health care coverage that is affordable. One solution currently being considered in Washington is healthcare funded by taxpayers and managed by the Federal Government. This would certainly address the issue of the uninsured. However, certain questions come to mind when considering this proposition. How are we going to pay for this? Do we think the Federal Government can do a better job of managing health care than the private sector? Who will make the medical decisions?

Consider the current state of the economy and the steps our leaders in Washington have taken to turn the situation around. How about money for stimulus and bailouts that has brought deficits to record levels? Bailing out particular industries like autos, banks, and insurance companies. Where do we draw the line? Will public heath care cost what we think it will? Will decisions be controlled by patients and their doctors or by bureaucrats focusing only on the numbers? Will Americans allow the government to draw the line on what is paid for and what isn’t?

If there was a way to fund such a plan for all Americans how can we expect it to work? One system often looked at is the Canadian system. Coverage is universal but healthcare is rationed by waiting time. The majority of Canadians wait more than 4 weeks to see a specialist. Some areas have a waiting time of almost 2 years for an MRI! Individuals can wait 2 to 3 years for a hip replacement. Patients must just deal with the pain and disability until they can get proper treatment. Canadian citizens are some of our northern states’ best customers as patients pay out of pocket in order to be seen in a timely manner. Are Americans going to be willing to wait for the medical care they are used to receiving without delay?

Another system often looked at is England’s. Coverage is universal, but health care is rationed in subtle ways. Thirteen hundred English patients die each year from cancer because the medication Herceptin is not approved by the National Health Service. Drugs for rare diseases are not even considered since the cost per patient is too high. In many countries, patients are not allowed to even pay for treatment themselves. If treatment is not approved, they must simply do without. Are Americans ready to accept doing without drugs or treatments that are not deemed cost effective? Are Americans willing to do without new drug discoveries and technologies as they must be balanced with costs?

A consensus exists among politicians and citizens as to what we would like to see in a healthcare system. We want a system emphasizing prevention, free of fraud and abuse, coverage for the uninsured, portability, freedom of choice, low costs, lack of rationing, and the best care available in the world. How do we achieve these lofty goals? Where are we willing to sacrifice?

The current plan proposed by the President would cost 1.6 trillion dollars over the next 10 years and only reduce the number of uninsured by 1/3. There are many ideas for funding, but each seems to have drawbacks for implementation. Every proposal asks for fundamental changes in what Americans expect of their health care system. Even though Americans as a whole find our present system wanting, the overwhelmingly vast majority are happy with their relationships with their doctors and the medical care they receive. Hopefully we can find a system which maintains patients’ trust in the medical care they receive and expands the same kind of care to all our citizens.