Health reforms have been tried many times in the past in USA but such efforts always got mired in arguments. This time around in 2010 though, the efforts resulted in a step forward when President Obama’s administration took up the challenge to introduce long overdue health reforms. After long debate and lot of political polarization it made it into the law. However, the final law got substantially diluted. Hence the efforts will need to be continued in future to incrementally make it more effective.
Some basics thoughts about the needs of citizens of a prosperous country.
All rich nations have accepted providing some basic services for their citizens as their moral duty. Examples of such services may be; compulsory and free education, health care plans, unemployment benefits, housing subsidies and the like. These services are considered almost an extension of other administrative responsibilities of governments, which are safety and security by police, road construction, street lights, adequate electricity, potable water, sewerage system, courts of justice and army defending boarders. In today’s democratic era the congress representing people has to decide which of the services are needed by people and prioritize them within available resources. At the end of the day, all these services are paid by the people directly or indirectly anyway.
If we start with the above paragraph as guide line, it is easy to understand that literally almost nothing is out of reach for the citizens of rich and strong USA. We all use many of the services enumerated above, but not necessarily equally and still we do not mind paying for them. We only have to expand this thought and extend the same philosophy for other necessary needs of citizens.
Let us imagine a simple situation; in all good conscience we cannot imagine, let alone allow, that our next door neighbor could die hungry when we have ample food. Health care needs must be taken in the same spirit. We simply cannot allow any American to die without a doctor or medical help when the disease is treatable and we can afford its cost. It is simply unacceptable to anyone. We need to accept health care of every individual as our national responsibility and moral duty as many other rich countries have done.
Population has always been the asset of any nation. In olden days particularly, when the army consisted of the citizens of the country, it was more appreciated that the healthy and strong citizens will make the whole nation look better, if they had to fight a common enemy. In the past few centuries, in the industrialized and technical world it has become more obvious that the citizens of the nation have to be well educated to be able to compete with other nations. It requires no further wisdom to understand that if the work force of the nation is well educated and healthy, they can better compete in the market place of the modern world. Hence the way we have free and compulsory education, it is also necessary to have free and compulsory health maintenance of the citizens of the country.
To make it easier and simpler, it would be much better if we provided such facility right from the conception to the last breath that one takes in this word. To make it sound catchy and simpler we may refer to such a health provision cover as Conception to Coffin (C2C) cover. If we do that and ensure the wellbeing of the fetus from day one, we may have better quality longer lives with lower Infant Mortality Rate (IMR). USA, the richest super power, owes it to its citizens to provide the most comprehensive health coverage..
Painful politics surrounding this important reform:
Almost half a dozen administrations have tried to give the US citizens much needed health care facilities in the past century, only to find that partisan politics and vested interests have not allowed it to happen. Those who opposed have used rumors and misguiding facts; worst amongst them being that this is a socialist (insinuating communist) plan, and that US cannot afford it because it is too expensive. Nothing can be further from truth. Despite appalling misguiding misinformation calling it “socialist reforms” and rumors of “death panels” the proposed reforms have become law in 2010, though substantially diluted than what we Americans need. It is not the best of the reforms, but it is a start none the less in the right direction. It will need many ongoing improvements, not because there is anything wrong, but because it has fallen short due to partisan politics and unfair give and take.
Amongst other similarly rich and developed nations USA is the only country not providing a satisfactory system of health care to its citizens. This is despite the fact that not only US can afford it, it is spending more than many other countries providing such care with a great sense of satisfaction amongst their citizens. According to World Health Organization (WHO) figures USA is spending as much as 15.3% of GDP on healthcare. Other countries of similar stature, which are rich, industrialized, democratic and literate, spend lesser with much better results. For example, Taiwan spends only 6.3% of its GDP and Japan only 8% of its GDP while many European nations spending somewhere in between these two figures. Despite almost double spending by US the health coverage is less, there are many citizens not covered and there is overall lesser satisfaction in beneficiaries in US than in Europe and other countries providing such facility.
History of health care reforms in world:
Since the late 19th century, Kings and Monarchs are disappearing and democracies are taking roots. All the rich, developed democratic countries are providing basic needs of citizens at a much better scale. Those nations, who can afford the expense, have been providing education, housing, health care and even food to their needy compatriots as a matter of right. Britain provides the longest unemployment benefits to its citizens (some people even define Britain as Socialistic Capitalism!). US legislators have tried to meet such goals regarding health care provision, but were defeated every time before this. Almost all the European countries have the health care satisfactorily provided. Other countries that have satisfactory health care facility in place for their citizens are Canada, Japan, Taiwan, Singapore, Hong Kong, and many other nations including almost whole of Europe. Even Cuba has a more satisfactory system than US in this regards. This tells us we are “wasting” a lot of money in the name of health care delivery. Let us examine this further.
The real and difficult truths about health care:
Some of the real and stark truths are kept hidden. Many citizens do not realize this fact because these issues are not discussed openly in public. Let me enumerate a few of these to expose how necessary the reforms are and why these need to be further changed as we go in to future. If these were openly discussed in public in such simple format, maybe we would not have needed a long debate to bring home an ideal health care system.
Truth is that our Medicare system for elderly in US is same as for all Canadian population. We have even borrowed the name “Medicare” from them. South Korea and Taiwan have adopted the same system. And surprisingly Medicare has highest acceptance and satisfaction of their users in US.
Truth is that for working people under 65 years of age, our health insurance and payment system is the same as that in France, Japan, Germany and almost every country providing such care. They all have the same template of employees and employers chipping in to cover the health of nation, except perhaps UK. However, the biggest difference between theirs and US system is that their insurance administration is “Not for Profit”, and hence not expensive. In US the Health Insurance companies are “For Profit” businesses owned by its share holders, who get about 15% profit and they carry almost 10% overheads. So, almost 25% of our premium is spent on administration and profit, as opposed to only about 5% in most other countries. Surprisingly, the cost of running Medicare in US is also about the same (5%).
Truth is that our “for profit” insurance companies are also failing their fiduciary and legal responsibilities because of conflict of interest. On one hand they are fiscally responsible to their share holders to make profit, while on other they are legally responsible to provide for health care needs of their insured from whom they have received a premium under contract.
Truth is also that more than 40 million Americans in US were uninsured and had no access to any health services until the new law came in and is becoming effective because the premiums are too steep. Either the cost of insurance has been beyond the reach of many, or a large number of them are not accepted by the insurance companies because of pre-existing conditions. These people are worse off than in any poorest country in Africa or Asia, because out of pocket health care is tremendously expensive in US. This leads to a lot of morbidity and mortality.
Truth is that as a super power and biggest economy, we cannot in good conscious allow our citizens go without medical facility or let them die, despite the fact that the condition is curable with present day medicine.
Truth is that because of our “for profit” health insurance system, there are so many gaps in coverage because the basic motive of the business is profit. Illnesses do not come by invitation or choice, it just happens. No individual may be allowed to be penalized for being sick, which in most cases is accidental or natural. There are gaps in present system like: life time expense ceilings, uncovered normal pregnancies, denial of pre-existing conditions, co-pay of different kinds, and deductibles. These results in huge bills, which when unpaid culminates into large number of Americans filing bankruptcies.
Truth is that our system has allowed promotion of vested interests of insurance companies, pharmaceutical companies, hospital groups, doctors, abusive defensive practice of medicine etc.
Truth is that our legal system has taken divorce from common sense in awarding very high amounts sometime for merely a small little harm caused by misjudgment of care provider, which may really not be negligence. This has resulted in “defensive medical practice”, wherein many unnecessary investigations and procedures are performed making it more expensive than what it really should be.
Truth is that health care should be available for the whole body. It must include vision, dental, mental health, preventive and curative.
Truth is that every individual must have a responsibility to one-self and to other fellow citizens and keep their insurance current, so that they are not a burden on common funds when falling sick. There is very negligible non compliance to this in other countries.
Truth is that every citizen must be provided a continuous health cover even if one looses job or becomes disabled. The government must cover the person for that gap until another job is found and person is once again insured under employer’s insurance plan.
Measures of common good for citizens:
We need to remember that US as nation need to continue efforts to provide legitimate rights to all our citizens. Improvements come in small steps, but surely they do. It has been only few decades since we have had universal voting rights and compulsory education, or even right to have fire brigade services common to all and not reserved for those who had money to obtain such facilities. Let us continue our efforts to ensure that all necessary services needed by citizens are not only accepted as their rights but the government provides these as a moral duty to each and every citizen without exception.
Lastly, the truth is that these reforms are historic and momentous reforms. Those who have helped it happen will go down in history and remembered for ever. Think of Tommy Douglas of Canada. Tommy started the Medicare in Saskatchewan in 1962 and the system was adopted as National Canadian system of Medicare in 1964. Tommy Douglas is rightly dubbed as “Father of Medicare”, which is still considered to be one of the best systems in the world. Douglas, who is said to be father of Medicare died in 1986, was voted the Greatest Canadian in 2004 in a TV poll, almost 18 years after his death, when many do not even know his name. That shows the importance and need of a fair and equitable Health care system in all nations. Even in US, Vermont is the first state to vote for Universal Health Care in May 2011 and will be signed into law soon. Before this in 2006 Massachusetts also introduced similar reforms. It seems US may be following Canadian example of incrementally adopting the Health care Reforms to meet the moral obligation of US to its citizens.