"Univeral health insurance is an imperative of social justice, because no one has complete control over whether or when illness will strike"Joseph A. Califano, Jr. (15)
Dr.Steffie Woolhandler and Dr. David U. Hummelsteen, who teach at Harvard Medical School, state the case for the United States' nationalizing health care. They say that "uncontrolled increases in health care costs have caused millions of Americans to forego needed health care or to be bankrupted as a result of health emergencies. For federal and state budgets, the increases mean less money available for investment in education, infrastructure and other needs. For business, especially small business, the burden of health insurance has become increasingly difficult to bear....The abolition of billing for service would with a single stroke eliminate the need for the entire insurance industry and much of doctors' office and hospitals' administrative expenses. Distribution of funds based on health care needs, rather than market forces, would save the money now spent on marketing. Eliminating corporate profit from the sale of health care would free up money for expanded health services and research. And abandoning litigation in favor of no-fault compensation for medical errors could direct remuneration to victims rather than attorneys and insurance companies....The extent of waste in our current health care system is much greater than most people realize. Conservatively, we estimate that 30% of health spending ($226 billion in 1991) is wasted on administration, profits, high physician incomes, marketing and defensive medicine, none of which goes to improve health care. Everyone now acknowledges that health care costs are higher in the United States than in other industrialized nations. One of every seven dollars spent in the United Statesfourteen percent of our gross national productgoes to the health care industry. This compares to six percent in Britain and eight percent in Canada. And both of these countries promote free care to all. Nationalization of the health care system would save both lives and money....Nearly every poll in the past thirty years has shown that a majority of Americans support a universal, comprehensive, publicly-administered health service of the kind that exists in Canada and western Europe." (16)
So, why don't we have it? Because it would eliminate health insurance companies, half the staff in doctors' and hospitals' offices (administrative costs consume over 15% of our health care costs), huge promotion budgets of pharmaceutical firms, lucrative services now done only in hospitals (such as renal dialysis which could be provided at home), and it would reduce physicians' incomes. Overall, this would save the public a tremendous amount of money, but the ones who are accustomed to living high on huge profits, strongly oppose a system that would give free health care to all.
Those who argue against universal health care claim that it results in large caseloads for doctors, less exam time, long waits to see a doctor, more people seeking free treatment for minor ailments, less money for tests, procedures and instruments, deteriorating facilities and long waiting lists for surgery. There is concern that cutbacks would affect the elderly and seriously ill.
According to Elaine Bernard, Past President of the New Democratic Party of British Columbia, Canada, and currently Director of the Trade Union Program at Harvard, Canada, after 40 years of universal health care, has waiting lists for surgery, but not for immediate or life-threatening needs. Canada has fewer high technology facilities, but the United States probably has more than it needs. Canada has a higher life expectancy and lower death rates from heart disease and infant mortality. (17)
"Primary and emergency care, universally insured, are readily available. No financial or administrative barriers prevent patients from seeking the services of any family doctor. Canadians visit physicians more often than Americans do and are highly satisfied with the service and the system. With a single insurer, the provincial government, there is far less paperwork for patients and doctors. More important is the widespread sense of security that comes from knowing that illness, however catastrophic, never results in financial disaster." (as quoted from Theodore R. Marmor and John Godfrey,
The New York Times
, July 23, 1991) (18)
"We need to return hospitals, medical supply companies, and pharmaceutical firms to the status of servants supported by the community or, in poor communities, by the state. Once deep interdependence exists between community and hospital, the community can create humane ways to care for needy members of society. If all healing systems were shifted to the service sector, competition among health care providers could disappear and everybody could work together to bring the best possible care at the lowest price." (19)
Since 1974, in Hawaii virtually all employers are required to provide health insurance for their employees. Small businesses form a large risk pool and get reduced insurance rates. The state provides health insurance for the poor, elderly and disabled. So far it is working well and could be used as a model for other states as an alternative to universal health care. (20)
Oregon had proposed a rationed care health plan, which listed 709 medical procedures and ranked them on the basis of their costs and benefits. If the treatment was too costly in that it was not likely to sufficiently to improve the patient's condition or was deemed of insufficient value to society, then it will not be paid for. It was to bring 120,000 poor people into Medicaid, but it also cut off other poor people who had received services before. (21)
"Oregon's cost-effectiveness list failed miserably. It had almost no published cost-effectiveness analyses to help it make its ranking....The rejection of the list as a priority-setting tool resulted from a wide array of moral controversies which Oregonians had not adequately sorted out." A highly publicized refusal of a bone marrow transplant for a seven-year-old leukemia patient embarrassed the Oregon legislature into dropping the plan. They had also been "accused of violating the Americans With Disabilities Act." (22)
"Patients and clinicians, especially physicians, form a moral relationship that goes beyond that of most professionals and clients. Patients often come to physicians in stressful, compromising situations. They usually rely on physicians to give them advice and counseling regarding their options, and to help them understand their clinical situation. They often feel vulnerable because of their illness (Pellegrino 1979). Sometimes they must reveal intimate secrets so that physicians can diagnose and treat them....With such knowledge and power come moral duties....Physicians are given special power by society: to prescribe medicines and to cut open people's bodies (with their permission, of course). With this knowledge and power comes a duty to advocate for patients' interests. Any decision to stray from absolute patient advocacy must be done with great caution and with significant moral justification....Because physicians have more knowledge than patients about clinical issues, patients have learned to trust physicians to recommend what is best for them, or to describe the risks and benefits of treatment alternatives in ways that will help them decide what is best for themselves. If physicians ration care costs, patients will no longer know how to interpret their recommendations: did the physician recommend conservative treatment to help me, or to save money?" (23)
Former U.S. Surgeon General, Dr. Everett Koop, stated, "I would rather ration greed than ration health care." (24)
Divide the class into two groups for a debate. The topic: "The United States should adopt a universal health plan." The students can draw upon their newly-acquired knowledge of both universal health coverage and rationed care to debate and rebut.