By Philip Caper, M.D.
Bangor Daily News, Nov. 17, 2011
America is the only wealthy country in the world that does not guarantee its people access to health care as a fundamental right. More than 15 percent of Americans are uninsured and many more are seriously underinsured. That was the bottom line message of T.R. Reid, author of the best-selling book “The Healing of America” and the television documentary based on it, “Sick Around The World.”
All other wealthy democracies provide universal health care to their residents, and do it for about half of what the U.S. spends. Reid, who was on a speaking tour of Maine last week, has studied health care in more than a dozen countries. He has concluded that America too could establish a universal health care system that covers everybody and simultaneously reduces overall costs. All that is required is the political will to do so.
Why has every country other than the U.S. made health care a human right? Reid attributes it to two basic factors.
The first is the ethic of “caring for the least of our brethren” shared by most of the world’s great cultures. They simply believe it is the right thing to do.
That’s not universally true in America. During a recent debate, Republican presidential candidates were asked whether somebody who had voluntarily decided to forgo health insurance but needed expensive life-saving treatment should be left to die. Many in the audience signaled their approval of that idea. One even shouted “let him die.” It’s clear that some Americans, worried about freeloaders or some other unworthy getting something they don’t deserve at public expense, are repelled by the idea of health care as a right.
My own experience, as well as the avalanche of negative coverage this episode generated, has convinced me that most Americans disagree. We are all human. At some unpredictable time in our lives most of us will become sick enough to require medical care. The chances of that happening increase as we age. All of us, if we’re lucky enough to live that long, will grow old and suffer from the infirmities that normally and inevitably accompany aging, but can be eased by good health care.
When — not if — that happens we will want to have that care available. For that reason, we should all be willing — and required — to participate in a health care system that protects us. Do unto others. Shared responsibility.
The second factor Reid cited is affordability. As strange as it seems, it turns out to be less expensive to include everybody in a health care system than to exclude some. In testimony before the Maine legislature last year, Harvard professor William Hsiao, one of Reid’s mentors, estimated that an improved Medicare-like system would produce annual savings to Mainers of a billion dollars. That’s right, a billion dollars every year.
I have yet another reason for wanting to see such a system enacted. A physician’s job is caring for the sick, no matter who they are. Our professional ethics do not permit us the luxury of deciding who is worthy of medical care and who is not.
Doctors want to work in a health care system that allows us to do our job. That job is to diagnose and treat disease, and to comfort patients according to our best professional judgment. In America, that is becoming increasingly difficult. The micromanagement of medical practice by outside parties is becoming commonplace.
No other country in the world would tolerate the degree of interference in medical practice that exists here. Doctors are becoming more and more frustrated with the conditions under which they must practice.
Such micromanagement is an attempt to save money and increase profitability for individual private insurance companies. But it adds hugely to our overall health care bill. In fact, it is estimated that up to 30 percent of our $2.7 trillion health care bill goes not for health care, but is squandered arguing about money — who gets what, and who pays. The effect on patients can be devastating.
Another lesson Reid learned in his travels is that in every country with a well-functioning health care system, government plays an overwhelmingly dominant role in financing, regulating or directly providing health care.
For the past 30 years, we have tried to let market forces govern our health care. That experiment has been a spectacular failure. Perhaps these excess costs could be justified if we produced superior results. But we don’t. According to the World Health Organization, many of our results are worse than other advanced nations, and few are better.
As a nation, we are already paying more than enough to care for every American, but we’re far from that goal. Even if the new federal health care reform law works perfectly, over 25 million Americans will be left out.
Reid, a self-described optimist, ended his tour by observing, “If the French can do it, so can Americans.” I agree. All we need is the will.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be contacted at email@example.com.