Wednesday, April 15, 2009

Thoughts About Universal Health Care

There are a few important health topics that I did not expect to learn about during my first two years of medical school. One such issue is the multitude of cases when a patient’s symptoms don’t follow the statistically predicted “textbook” course. Another example is the legal dilemmas doctors face while contemplating their practices. However, one matter that is particularly overlooked is a knowledge about the US healthcare system.

This month, a discussion about healthcare emerged as the topic of my ethics small group. Sixty minutes and three articles later, I am not sure how much I gained. One thing that I know for sure- my thirst for knowledge and conversation on this topic is currently much bigger than that for osteology of the skull.

Intellectually and morally, I do not simply want to acknowledge the fact that our health care system needs repair. I want to come up with my own plausible idea that could actually function to make it better. This is a task that no state or country government has been able to perfectly address, so it requires a lot of assessment.

In fact, I’ve been thinking about it for years- even before I decided to go to medical school. The first time I heard of the idea of universal health care, I was a college sophomore attending an event about local NGO organizations looking for volunteers. One such group was advocating “health care for all!” As a young middle-class person who had been covered by my father’s employer for my whole life, it seemed like a strange idea. I never perceived a problem with getting access to care, even despite some complicated medical problems during my youth.

When I later spoke with my father by phone (my main sounding-board for verifying new intellectual ideas), he said, “Oh sure! Of course we should have a national health plan. Don’t you know that every industrialized country except the US provides health care?” His comments rattled me. I felt like I had when I realized that the USA was one of the only countries in the world that allowed the death penalty. Suddenly, the visions of my dad opening letters from the insurance companies with total frustration and dismay poured into my mind. Because I had never personally had a problem with health care, I assumed it wasn’t a big issue.

Furthermore, when I graduated from college a few years later, I thought it would be alright to go three months uninsured as I transitioned from my parents plan to an employer’s plan that I would be eligible for after 90 days. I realized I was wrong about that too when my mother passionately exclaimed that in one moment a car could swipe me off a street corner and cause damage of millions and millions of dollars. Whew! Ok, I conceded.

That fall I had a bicycling accident that took me to the emergency room for x-rays and pain medication. I fractured my olecranon (that means “elbow” in anatomy language), and according to my little brother, had a swollen face that made me look like a monkey, Needless to say, I was humbled as I realized that my life could have been a total disaster had a not been insured.

Fast forward to now, and I am completely convinced the USA needs some type of national plan. I’m not convinced that the health care situation is the worst in the world. After all, we have a good education system, lots of research and experimental treatments, access to anything available if you have resources, and knowledgable doctors who don’t take bribes (as a side not, if you want to read something about the bribe-driven medical system in Eastern Europe to make you feel the USA isn’t so bad after all, see this NYT article).

Actually, the US already has a national plan, but it is disorganized and unrecognized. Medicaid and Medicare provide payment for over 50% of the medical costs in our nation, a number, a number that's about 15.2% of our GNP,as well as the capital which insurance companies pay. All prisoners, soldiers, Peace Corps Volunteers and veterans legally have access to free medical care.

I visited a veterans hospital in Nebraska this winter, and was surprised by the advanced computer-systems- which provide information about any veteran to a variety of hospitals in the region. My own doctor’s office won’t even share within the building. Whether Medicaid or health care systems for prisoners work as well as the veterans system is debatable. However, my own grandparents are receiving plenty of medical treatment (even more than my grandmother can rationalize) covered under their Medicare plan.

The problem is that health care costs are sky-rocketing— the graph shows a sharp line upward, even with all other factors, such as income and inflation, adjusted. I’ve heard that Medicare won’t be left to cover my generation. Additionally, the costs have risen so much that a growing number of insured people are unable to access care and pay their medical bills. This has raised the awareness about creating a national plan—or reorganizing the current plans as the case may be—and I firmly believe that in the next few years we will see some major changes.

According to the UN’s Universal Declaration of Human Rights Article 25, healthcare IS a right. But whether or not it is a right, we can all agree that morally a government should provide some care for those who can’t afford it. For example, we provide food stamps to those who qualify (maybe it’s not the best nutrition, but the US government gives people food). Our taxes pay for a fire service, regardless of who has fires. They also pay for public schools, even if we don’t have children or send our kids to private schools. So, why not also expand the idea to provide some type of basic care, which would exist as a free option to those who need it? Nobody would be forced to go there. Doctors wouldn’t be forced to work there. And nobody would take away the private care or insurance companies that already exist. It would be an option (and actually I think I’d be honored to work there helping people who really need the care).

However, I’m afraid that the only steps the US will take first is via subsidized insurance coverage—often with private insurers, rather than creating state-owned hospitals. It’s less change, requires less capital and work up-front, and perhaps people can accept it more easily because it seems less-nationalized? Yet, mandating insurance coverage really isn’t the same as providing basic care via a state-run, state-owned operation.

Massachusetts is considered to be “ahead” of the nation with their health care laws that require all people to have insurance. Additionally, laws were passed that guideline basic coverage to protect consumers. For example, in MA no person can be denied coverage for a pre-existing condition, and insurance companies must pay for fertility treatments regardless of age. All people of low-income status qualify for subsidized insurance plans- except students (who currently aren’t covered by any subsidized plans, but that’s another long story). Currently the state can’t afford its own legislation because it also has the most expensive care of any state in the country.

I believe this demonstrates that legislature needs to address several areas- not only the coverage of insurance providers, but also the cost for care that is set by private hospitals and clinics. It is ridiculous that most people have no idea how much their treatments will cost before they get them- and furthermore cannot even get a straight answer when they ask. The reason of course is that cost fluctuates depending on whether one has insurance, which insurance, no insurance, which doctor, what complications, how many blankets you asked for (just ask my friend Eva who was billed individually $20 for each blanket she used), etc.

Many Americans are afraid of more government involvement, but frankly, I am afraid of what will happen in our government doesn’t get more involved. Of course the truth of the matter is that most countries with state-run hospitals and completely free care have higher taxes (the current tax rate is about 30% in the USA, and about 60% in European countries –as a rough estimate), and they pay their doctors less (should be noted that they also have free medical tuition).

I think America can devise something new- perhaps even by reorganizing the current budget without raising taxes. One proposal was that people could have a deductible based on their pre-tax salary. Although honestly, I would definitely be willing to pay 5-10% more taxes if I never had to worry about insurance again. Somewhere the line will have to be drawn to decide what care will be free (or partially covered) in order to maintain a sustainable system for all. Obviously, cosmetic and dental care may be out of the question, but this is the part I really haven’t figure out yet—where do we draw a line? The decision should probably be made by a group of doctors and policy-makers appointed by elected officials, and not lowly medical students like myself. Yet, I continue to ponder about this issue, and I wonder what others think.


Kevin said...

I believe America's health care system is the best in the world. People come from all over the world for American health care. I don't believe everyone is lamenting over the lack of health care. I believe this is a political ploy about health care insurance. (Insurance = money = control)

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