A few weeks ago, an article by Noam Levey of the Los Angeles Times caught my eye. It was titled “Global Push to Guarantee Health Coverage Leaves U.S. Behind” and it described how “even as Americans debate whether to scrap President Obama’s health care law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.”
Among those other countries are China, Thailand, Mexico, Rwanda and Ghana. The article went on to explain that, “Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.”
Many other countries are moving full speed ahead to guarantee health care for all their citizens, not only because it is morally and ethically right but because it is a powerful economic development tool that will ensure these countries have healthy populations and an efficient and effective health care system.
Meanwhile, the U.S. seems stuck in a state of political paralysis and may soon move full speed astern. What explains this striking and unfortunate example of American exceptionalism?
I attribute it to motivators often used to explain the behavior of Wall Street: fear and greed.
I would also add a third: ignorance. There are those who still believe (or claim to), despite all the evidence to the contrary, that the U.S. has the best health care system in the world. This belief is demonstrably contradicted, both by the facts and everyday experience. We have the most expensive health care system in the world and some of the fanciest technology, but our arrangement for getting health services to our people ranks far down the scale, behind about 40 other countries.
Fear is a major factor in the political stalemate we are now witnessing surrounding health care reform. About 50 million people in the U.S. are uninsured and increasing numbers are badly underinsured. Bankruptcies and other financial hardships due to medical costs are becoming more and more common.
Despite this, we are treated almost daily to distracting arguments, many unfounded and ridiculous, about “death panels,” “government tyranny,” “rationing” and other largely mythical or irrelevant threats to our well-being. Some of the critics responsible for these fear tactics are simply misinformed, but others are dissembling to pursue obstructionist political agendas.
Much of the fear-mongering around the health care reform debate is induced by the second motivator: greed. Health care in the U.S. is almost a $3 trillion industry. It is credibly estimated that about a third of our spending does not contribute to the health of our people in any meaningful way. The proof is that other wealthy nations provide health care to their people for about half of what we spend yet get better results.
Elimination (or more accurately redirection) of some of that money would mean moving funds away from a few people and toward the rest of us, thereby reducing the income of influential industries such as large pharmaceutical and medical supply companies and corporate providers of health care services. Many of these companies are enjoying windfall profits thanks to American public policy. Greed and the political muscle that goes with money are a major source of resistance to changes that would benefit the vast majority of Americans.
Our market-driven health care system is disintegrating. Many are being harmed in the process. How can people of good conscience allow this to continue? We need to change the ways we finance, pay for and deliver health care.
Our for-profit insurance and delivery systems must be transformed (not just reformed) into nonprofit ones, like most other countries. Coverage must be expanded to include everybody. Firm, fair and effective cost controls need to be put in place. In order for widespread support for such a system to be sustained, everyone must be in the same system.
In other words, we must replace our existing system sustained by fear, greed and ignorance with one that is fair, inclusive, efficient, effective and mission-driven. Such transformation has occurred elsewhere. Given the political will, we in the U.S., including Maine, could do it too. We’d all be much better off.
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 reached at email@example.com.