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10 EXCELLENT REASONS FOR NATIONAL HEALTH CARE |
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1. It's good for our health Martha Livingston Most of the time, most of us don't need health care. What happens in our daily lives has at least as much impact on our health as whether or not we have health insurance. Do we have a home that's not too cold in winter or too hot in summer, not too crowded, in a clean, safe environment? Do we have enough of the right kinds of foods to eat? Do we have satisfying work that pays enough for us to afford a decent life? Do we have time to enjoy our families and friends? Are our kids and our elders well cared for? Or are we living in a stressful, overcrowded environment, working too many unpleasant hours just to get by, eating on the run? Our health is usually affected much more by these life circumstances than by health care. But -- of course -- we all need health care some of the time. Part of being able to live a healthy life is having an ongoing relationship with a health care professional who knows our lives as well as our lab results. Our doctor may provide suggestions about habits we can change to improve our health, may send us to a nutritionist, may recommend physical activity, may recognize aspects of our home, neighborhood, and working environment that are affecting our health, may prescribe medication, may discover potentially serious conditions before we know they're there, and so forth. This is called primary care, and it's crucial to our well-being. Primary care doctors and nurse-practitioners like to call this relationship our "medical home." Having such an ongoing relationship becomes absolutely critical, of course, when we're sick. Primary care, far less expensive than critical or emergency care, is what we most often go without when we aren't insured or when we have high-deductible insurance policies or coverage that excludes routine or preventive care. Insurance companies, knowing that they are not likely to be covering the same lives (yes, they call us "covered lives," not people) for very long, cynically save money by not paying for preventive care, even though the system as a whole becomes more expensive, and our health suffers as a result, when we become sicker and turn up for emergency care later on. With national health insurance, we'd be able to choose any doctor, nurse-practitioner, midwife, or other caregiver. Even those of us who have private insurance now are often quite limited in our choice of caregiver, depending on which caregivers participate in the insurance plan chosen by our employer. Employers, increasingly strapped by escalating health care costs, may change insurance plans year by year, forcing us to change primary- care providers because insurance plans include limited panels of doctors, which makes having a long-term relationship with a caregiver, a "medical home," close to impossible. For those of us who are uninsured or underinsured, it's even harder to find a medical home. Safety-net providers such as hospital-based health clinics do their best with limited resources, but continuity of care -- seeing the same doctor or nurse-practitioner -- is a luxury they're not able to offer. Once finished with their medical training, medical interns and residents move on. Of course, the lack of a medical home is not the only consequence for those tens of millions who are uninsured or underinsured. Often they are simply unable to get help when they need it. The result is tragic: the health of millions of us is a good deal worse than it could be, and many thousands of Americans will prematurely get sick or die. The latest analyses estimate that anywhere from 22,000 to 101,000 Americans die every year of treatable conditions simply because they were uninsured and could not get timely care. [1] [2] But the problem is much, much larger than that. Think about the major, common health problems in the United States: heart disease, cancer, diabetes. There are about 21 million Americans with diabetes -- and millions of them don't even know it. Diabetes is a silent condition. Americans without access to routine checkups may not learn that they have this life-threatening condition until many years later, when they turn up in emergency rooms with heart attacks, kidney failure, and other killer diseases. The same can be said for hypertension, which leads to death and disability from heart disease and stroke. Well-insured Americans with cancer live longer and survive their disease at a much higher rate than under- or uninsured Americans, primarily because they get diagnosed and treated more quickly and by better specialists. [3] American women are dying of an almost completely treatable condition, cervical cancer, because they lack access to a simple Pap smear, considered "routine" and therefore very often not covered. [4] Many women in the United States can't get prenatal care, although the astronomical cost of treating even one seriously ill newborn could pay for prenatal care for hundreds of women. We do quite badly in terms of infant mortality, worse than twenty-six other countries in the world; close to seven of every thousand U.S. babies die before their first birthday, compared with three or fewer in Iceland, Sweden, Luxembourg, and Japan. [5] Our neonatal mortality (death before twenty-eight days of age) ranks behind all but one of thirty-three countries. [6] Women in the United States are more likely to die in childbirth than women in thirty-two other nations -- including all of the other wealthy nations and some a good deal less wealthy than we (e.g., Latvia). [7] On life expectancy, the ultimate health outcome, Americans fare worse than our counterparts in all of the other wealthy countries: we rank twenty-second for men, who live, on average, to 75.2 years, and twenty-third for women, at 80.4 years. [8] While access to health care isn't responsible for all health outcomes, it's part of the picture, and that picture, in the United States, is shameful: people get sicker, and die sooner, because they cannot get health care when they need it. These health outcomes aren't limited only to the un- and underinsured; when some of us can't get care, and get sicker, everyone's health suffers. Consider, for example, the woman coughing near you on the subway. Might she have untreated, and contagious, TB? Wouldn't it be reassuring to know that she and all of our neighbors were able to seek medical care when they needed it? Clearly, we can do better. All of the other wealthy, industrialized countries in the world have; they all have some form of national health care, in which people can get health care when they need it without having to worry about where the money will come from. No one's system is perfect; each nation's health care is paid for, organized, and delivered differently, in accordance with that nation's history and culture. [9] (In fact, in Japan people see the doctor much more frequently, and spend many more days in the hospital, than in any other wealthy nation. And in Germany, spa treatments are considered medically necessary for some patients.) How countries pay for care also varies: Milton I. Roemer refers to the "continuum of government intervention," ranging from the United States's free-market approach to financing care through a single-payer or similar system (known as national health Insurance, such as in Canada), to organizing the delivery of care (known as a national health service, such as in the United Kingdom), to socialized medicine, in which the government owns the health care facilities and employs the health care workers and professionals (such as the Veterans Administration system in the United States, or the national system in Cuba). [10] It should be noted that while private insurance plays a role in some European systems, that role is quite small, and it is highly regulated. How doctors and other health care professionals are paid varies as well. In some countries, doctors are on salary; in some, doctors are paid a fixed amount per patient on their roster (known as a capitation system). In some, doctors and other caregivers are paid for each service they provide; that's called "fee-for-service." There are strengths and drawbacks to each method of payment; for example, in a fee-for-service system, doctors are not adequately reimbursed for lengthy office visits and patient education, but for doing things. Of course, as patients, we don't think about payment mechanisms; we think about health care. We experience the consequences of different systems but aren't aware of them. Most countries allow doctors to practice both within the national system and outside it, in private practice. This may make a particular specialist hard to get to see in the public system; time spent seeing private patients is, after all, time not available to national health system patients. One strength of Canada's system is that doctors are not allowed to provide medically necessary care both publicly and privately. As a result, very few Canadian doctors -- just over one hundred nationwide, in 2006 -- choose to "opt out" of the public system. [11] Canadians are especially proud of the equity that this aspect of their system affords to all. Simply guaranteeing that people have access to needed health care hasn't meant, in Canada or elsewhere, that such debates are settled; far from it. Rather, it creates the possibility of a national discussion about how health care might best be organized and delivered. We in the United States have been subjected to a drumbeat of mis- and disinformation about national health care systems, because it's an effective way to scare Americans, the majority of whom, according to the polls, are eager for the government to take control over a clearly broken health insurance system. [12] Opponents of a Medicare-for-All solution to our health care mess refer to our plan as "socialized medicine," which it clearly is not. The most common myths are that people in other countries have to wait in line for urgently needed care, that care is rationed, and that those rich enough to do so come to the United States for care unavailable to them in their home countries. These myths get repeated over and over despite there being little evidence in support of these claims. I'm most familiar with myths about Canada's health care system, having lived and studied there. At age seventy-three, Peter Smoliett, a retired film professor living in Toronto who had had mild, stable angina (chest pain) for ten years and hypertension for twenty years as well as Type 2 diabetes, experienced severe, unstable angina. He was admitted to the hospital immediately and found to require quadruple bypass surgery as well as a heart valve replacement. He was referred to the best surgeon in Toronto, was transferred to that surgeon's hospital, and had the surgery within days. His wife, Eleanor, also a retired professor, reported some weeks later, after Peter's successful surgery and discharge with home nursing, "For your health advocacy work, you might be interested in knowing of our out-of-pocket costs to date (26 days in hospital): in-hospital dentistry required before surgery could proceed, about $200; hospital phone connection, about $20; bedside television rental, about $330; hospital bed rental and delivery, about $200; extra local transport -- taxis, subway, parking -- about $150; extra phoning, snacks out, etc., about $50. Total: about $950 (then about $750 U.S. [13])." Several years earlier, Peter had been treated for a rare cancer of the neck. Because he resides in Canada, he was able to locate and be treated by the most knowledgeable doctor on his rare condition, and his care was world class in that situation as well. Throughout the United States, the richest country in the world with the most expensive health care in the world, uninsured people are lining up at free clinics run by medical professionals and students to get care they can't get anywhere else. Larry Towell and Sara Corbett, in a 2007 photo essay, documented a three-day annual health care "fair" in Virginia run by a group that spends most of its year bringing care to Haiti, India, Tanzania, and other poor countries. [14] From Friday morning to Sunday night, doctors, dentists, and nurses work in tents to bring some relief to Americans who are, in a sense, medically homeless. Patients needing treatment, from dental care to cancer care, are seen in this marathon; hundreds are turned away because the demand is just too great. One emergency-room doctor volunteering at the "fair" said, "If you spend a day here, you see there's something wrong with health care in this country." Scenes like this could play out every day in cities and towns across the country, in free clinics. From France to Japan, from Australia to Norway, in every other industrialized nation in the world, people are able to get the care they need. The United States is alone in failing to provide care to all. It's time for us to join the rest of the wealthy nations of the world and give everyone of us, not just some lucky ones, a medical home at last.
PUSH TO IMPORT CANADIAN MEDICINES _______________ Note: Martha Livingston, PhD, is Associate Professor of Health and Society at the State University of New York College at Old Westbury.
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