MOTION #76: THIS HOUSE WOULD INTRODUCE A SYSTEM OF UNIVERSAL
HEALTHCARE
On March 23rd 2010,
U.S. President Barack Obama signed into law the Patient Protection and
Affordable Care Act, an act the New York Times calls “the most expansive social
legislation enacted in decades”.
The law’s purpose is
to insure 30 million more Americans by expanding Medicaid and introducing
federal subsidies aimed at lower-income citizens to aid them in buying private
health insurance. It will also prohibit insurers from denying coverage based on
pre-existing conditions, create a panel of experts to reduce government
reimbursements under Medicare and create incentives for better, bundled
services.
However, not all share
this vision of the bill and the idea it stands for. Including the successful
vote for repealing the legislation in the House, there have been numerous legal
challenges launched against it, charging it with being unconstitutional,
splitting judges’ in addition to politicians’ opinions down ideological lines.
Additionally, Vermont
has recently adopted legislature with the aim of introducing a single-payer
form of healthcare, a system where a single provider, usually the government,
by 2017, provides all the financing.
With the legislature and the judiciary involved with their arguments, there
were 52 million uninsured Americans in 2010, 9 million new on account of
unemployment[5], making the need for such a policy more necessary than ever.
Yet on the other hand, the economic downturn shows no signs of abating, thus
making the adoption of 930bn dollar bill a costly enterprise for the government
and, therefore, for the average taxpayer.
Pros
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Cons
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Health care would substantially reduce overall costs. With universal health care, people are able to seek
preventive treatment. This means having tests and check-ups before they feel
ill, so that conditions can be picked up in their early stages when they are
easy to treat. For example in a recent study 70% of women with health
insurance knew their cholesterol level, while only 50% of uninsured women
did. In the end, people who do not get preventive health care will get
treatment only when their disease is more advanced. As a result their care
will cost more and the outcomes are likely to be much worse. Preventative
care, made more accessible, can function the same way, reducing the costs
further.
In addition, a single-payer system reduces the
administrative costs. A different way of charging for the care, not by
individual services but by outcomes, as proposed by Obama’s bill, also
changes incentives from as many tests and procedures as possible to as many
patients treated and healed as possible.
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While the idea that
better access to preventative medicine will quickly and drastically lower
general medical care costs is an incredible notion, it sadly is just that – a
notion.
As an aside, the
same argument – lowered costs – could be made for simply improving the
existing tactics of preventative medicine without the need to invest into
universal coverage.
Returning to this
proposition though, while it might be realistic to expect some reduction in
costs from improved prevention, those would very unlikely ever amount to a
significant amount – and certainly not an amount that would make introducing
universal health coverage a feasible strategy.
Universal health care will cause people to use the
health care system more. If they are covered, they will go to the doctor when
they do not really need to, and will become heavy users of the system. We can
see in other countries that this heavier use leads to delays in treatment and
constant demands for more resources. As a result care is rationed and taxes
keep going up.
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Current health care systems are not sustainable. American health insurance payments are very high and
rising rapidly. Even employer-subsidised programs are very expensive for many
Americans, because they often require co-payments or high deductibles
(payment for the first part of any treatment). In any case employee health
benefits are being withdrawn by many companies as a way of cutting costs. For
those without insurance, a relatively minor illness or injury can be a
financial disaster. It is unfair that many ordinary hard-working Americans
can no longer afford decent medical treatment.
Moving to a system of universal health care would
reduce the burden on human resources personnel in companies. At present they
must make sure the company is obeying the very many federal laws about the
provision of health insurance. With a universal system where the government
was the single-payer, these regulations would not apply and the costs of
American businesses would be much reduced.
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A range of health
programs are already available. Many employers offer health insurance and
some people deliberately choose to work for such companies for these
benefits, even if the pay is a little lower. Other plans can be purchased by
individuals with no need to rely on an employer. This means they are free to
choose the level of care which is most appropriate to their needs. For other
people it can be perfectly reasonable to decide to go without health
insurance. Healthy younger adults will on average save money by choosing not
to pay high insurance premiums, covering any necessary treatment out of their
own pockets from time to time. Why should the state take away all these
people’s freedom of choice by imposing a one-size-fits-all socialist system
of health care?
Human resources professionals will still be needed to
deal with the very many other employment regulations put in place by the
federal government. Instead of employees being able to exercise control over
their health care choices and work with people in their company, patients
will be forced to deal with the nameless, faceless members of the government
bureaucracy.
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Healthcare has been recognised as a right. The two crucial dimensions of the topic of introducing
universal health care are morality and the affordability.
Paragraph 1 of Article 25 of the Universal Declaration
of Human Rights states the following: “Everyone has the right to a standard
of living adequate for the health and well-being of himself and of his
family, including food, clothing, housing and medical care and necessary
social services, and the right to security in the event of unemployment,
sickness, disability, widowhood, old age or other lack of livelihood in
circumstances beyond his control.”
Analyzing the text, we see that medical care, in so
far, as it provides adequate health and well-being is considered a human
right by the international community. In addition, it also states, that this
right extends also to periods of unemployment, sickness, disability, and so
forth.
Despite this, why should we consider health care a
human right? Because health is an essential prerequisite for a functional
individual – one that is capable of free expression for instance – and a
functional society – one capable of holding elections, not hampered by
communicable diseases, to point to just one example.
Universal health care provided by the state to all its
citizens is the only form of health care that can provide what is outlined in
the Declaration.
In the US the only conditions truly universally covered
are medical emergencies. But life without the immediate danger of death hardly
constitutes an adequate standard of health and well-being. Additionally,
programs such as Medicaid and Medicare do the same, yet again, only for
certain parts of the population, not really providing the necessary care for
the entire society.
Further, the current system of health care actively
removes health insurance from the unemployed, since most (61%) of Americans
are insured through their employers – thus not respecting the provision that
demands care also in the case of unemployment.
But does insurance equal health care? In a word: yes.
Given the incredible cost of modern and sophisticated medical care – a
colonoscopy can cost more than 3000 dollars – in practice, those who are not
insured are also not treated.
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There are several
reasons why health care should not be considered a universal human right.
The first issue is
one of definition – how do we define the services that need to be rendered in
order for them to qualify as adequate health care? Where do we draw the line?
Emergency surgery, sure, but how about cosmetic surgery?
The second is that
all human rights have a clear addressee, an entity that needs to protect this
right. But who is targeted here? The government? What if we opt for a private
yet universal health coverage – is this any less moral? Let’s forget the
institutions for a second, should this moral duty of health care fall solely
on the doctors perhaps?
In essence, viewing
health care as a right robs us of another, much more essential one – that of
the right to one’s own life and one’s livelihood. If it is not considered a
service to be rendered, than how could a doctor charge for it? She couldn’t!
If it were a right, than each of us would own it, it would have to be
inseparable from us. Yet, we don’t and we can’t.
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It is not, in fact, universal health care itself,
that’s inefficient, but specific adaptations of it. Often, even those
shortcomings are so blown out of proportion that it’s very difficult to get
the whole story.
Universal health care can come in many shapes and
sizes, meant to fit all kinds of countries and societies. When judging them
it’s often useful to turn to those societies for critiques of their coverage
systems.
Despite the horror stories about the British NHS, it
costs 60% less per person than the current US system. Despite the haunting
depictions of decades long waiting lists, Canadians with chronic conditions
are much more satisfied with the treatment received than their US
counterparts.
We should not let hysterical reporting to divert us
from the truth – universal health care makes a lot of economic, and, more
importantly, moral sense.
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Universal healthcare
systems are inefficient. One of the
countries lauded for its universal health care is France. So what has the
introduction of universal coverage brought the French? Costs and waiting
lists.
France’s system of
single-payer health coverage goes like this: the taxpayers fund a state
insurer called Assurance Maladie, so that even patients who cannot afford
treatment can get it. Now although, at face value, France spends less on
healthcare and achieves better public health metrics (such as infant
mortality), it has a big problem. The state insurer has been deep in debt
since 1989, which has now reached 15 billion euros.
Another major
problem with universal health care efficiency is waiting lists. In 2006 in
Britain it was reported that almost a million Britons were waiting for
admission to hospitals for procedures. In Sweden the lists for heart surgery
are 25 weeks long and hip replacements take a year. Very telling is a ruling
by the Canadian Supreme Court, another champion of universal health care:
“access to a waiting list is not access to health care”. Universal health
coverage does sound nice in theory, but the dual cancers of costs and waiting
lists make it a subpar option when looking for a solution to offer Americans
efficient, affordable and accessible health care.
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We need to analyze this issue from a couple of
different perspectives.
The first is this trillion per decade cost. Is this
truly a cost to the American economy? We think not, since this money will
simply flow back into the economy, back into the hands of health care
providers, insurance companies, etc. – back into the hands of taxpayers. So
in this sense it is very much affordable.
But is this a productive enterprise? For the millions
of people that at this very moment have absolutely no insurance and therefore
very limited access to health care, the answer is very clear.
In addition, the reform will more or less pay for
itself, not in a year, not even a decade – but as it stands now, it’s been
designed to have a net worth of zero.
Lastly, just because we live in a bad economic climate
doesn’t mean we can simply abandon all sense of moral obligation. There are
people suffering because of the current situation. No cost can offset that.
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Universal healthcare
is not affordable. No policy is
created, debated or implemented in a vacuum. The backdrop of implementing
universal health coverage now is, unfortunately, the greatest economic
downturn of the last 80 years. Although the National Bureau of Economic
Research declared the recession to be over, we are not out of the woods yet.
Is it really the time to be considering a costly investment?
With estimates that
the cost of this investment might reach 1.5 trillion dollars in the next
decade, the answer is a resounding no. Even the Center on Budget and Policy
Priorities – a left leaning think tank – opined that the Congress could not
come up with the necessary funding to go ahead with the health reform without
introducing some very unpopular policies.
Does this mean universal health care should be
introduced at one time in the future? Not likely. Given that there are no
realistic policies in place to substantially reduce the “riot inducing” US
public debt and the trend of always increasing health care costs the time
when introducing universal health care affordably and responsibly will seem
ever further away.
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Profits do drive innovation. But there is nothing out
there that would make us believes that the profits stemming from the health
care industry are going to taper off or even decrease in a universal coverage
system. In short in a single-payer system, it’s just the government that’ll be
picking up the tab and not the private companies. But the money will still be
there.
An expert on the issue from the Brigham and Women’s
Hospital opined that this lack of innovation crops up every time there is
talk of a health care reform, usually from the pharmaceutical industry, and
usually for reasons completely unrelated to the policy proposed.
Whereas the opposition fears new research into
efficiency of medical practice and procedures, we, on the other hand, feel
that’s exactly what the doctor ordered – and doctors do too.
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Universal healthcare
stifles innovation. Profits drive
innovation. That’s the long and short of it. Medical care is not exception,
albeit the situation is a bit more complicated in this case.
The US’s current
system has a marketplace of different private insurers capable of making
individual and often different decisions on how and which procedures they’ll
choose to cover. Their decisions are something that helps shape and drive new
and different practices in hospitals. A simple example is one of virtual
colonoscopies. Without getting into the nitty gritty, they often require
follow up procedures, yet are very popular with patients. Some insurers value
the first, some the other, but none have the power to force the health care providers
to choose one or the other. They’re free to decide for themselves, innovate
with guidelines, even new procedures. Those are then communicated back to
insurers, influencing them in turn and completing the cycle.
What introducing a single-payer universal health
coverage would do is introduce a single overwhelming player into this field –
the government. Since we have seen how the insurer can often shape the care,
what such a monopoly does is opens up the possibility of top-down mandates as
to what this care should be. With talk of “comparative effectiveness
research”, tasked with finding optimal cost-effective methods of treatment,
the process has already begun.
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