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This editorial was written by Project EINO’s Director, Dennis Lazof, and board member Jonathan Kotch. It was posted on April 10, 2005. Project EINO currently operates as the national project for the NC Committee to Defend Health Care
FACING THE CHALLENGE,
EXTENDING HEALTH CARE UNIVERSALLY
In a recent article appearing in the journal "Health Affairs" entitled "Change in Challenging Times: A Plan For Extending And Improving Health Coverage", the authors got a lot right about fixing the lousy US health care system. Lambrew, Podesta, and Shaw correctly assessed that throughout most of the range of value systems functioning in our diverse nation it is wrong to tolerate avoidable pain and death of others. They correctly conclude that Americans will eventually demand universal health coverage from our representatives. The public will make such a demand quickly once they become aware of the clear evidence that we are already paying enough to fund such a system with high quality care and improved health outcomes. The authors, however, miss the point entirely in terms of how we need to get started in replacing our system.
Our democracy cannot flourish and will likely not long survive maintaining barriers around those basic resources which are necessary to provide individuals a fair shot at active participation and creative self-expression. Health care as a privilege for a shrinking class within our society (one in three non-elderly adults uninsured presently with a 25% projected increase in 2013 over 2003) will certainly undermine broad opportunities for productive lives and, even, competitiveness of American business. That the excluded and underprivileged are disproportionately ethnic minorities and largely low-income workers makes obvious the deception of the "American myth" (i.e. hard work and individual sacrifice pays off). This will shake both major political parties.
Either health care remains a privilege for some, or it shall become the right of all. Education made this quantum leap decades ago when it was written into 49 state constitutions, after considerable popular demand and mobilization. Before the federal government took any action to support the state level reform, a right to education was written into 32 state constitutions. Once we make clear our commitment to health care as a right of all Americans, political mechanisms and, hopefully, a good deal of professional expertise and reasoning from sound data, will come to bear in devising and implementing a promising system to fulfill that right. There are many variations of what such a system might look like. The authors of "Challenging Times" present one of those options, which would, at best only approach fulfillment of the governmental obligation that a "Right to Health Care" involves. Other, more efficient and less costly manners of assuring quality care to all Americans certainly also exist. Among those certainly single-payer health care needs to be considered.
It is obvious that there is no predetermined financial barrier to insuring all Americans. This is clear from the fact that we already spend per capita twice that which other industrialized nations spend to insure their entire populations. It is further supported by estimates of what we currently waste on redundant administration, egregious salaries for top level administrators and litigation. Litigation costs, by the way, are exacerbated by a system founded on distrust and which cedes the central management role to players who are legally bound to act on the basis of "return on investment". Then, there is the "uncompensated care" and all the indirect expenses we incur collectively from our failing health care system. For example additional costs of crime, litigation and incarceration which would have been avoidable in a society with well-developed mental health care, including quality substance abuse programs. There is no question but that our experts in public health and in health services research have the ability to fashion an efficient system of providing and funding health care. This expertise has been developed and is maintained already at public expense, or great public subsidy. Why not fully challenge them for developing and implementing what the public needs?
What the authors of "Challenging Times" missed wide on was that now we find ourselves at the point of needing to be clear about just these one or two most poignant and essential facts, those facts which every American needs to appreciate. These are that we already pay for a high quality universal system and that we don't get back the quality that we pay for. We should not otherwise be wasting our time and energy arguing about the myriad of possible funding plans with all their details for efficiency. Even more clearly, we should not now be wasting time discussing small tweaks and technological additions, the effects of which will be insignificant at best. Rather, our first order of business must be to take the step of commitment. That commitment would best be expressed as widespread medical professional endorsement and public demand for a "Right to Health Care" for all Americans.
Once we have achieved this first step which is our challenge at this moment, then we can hold the legislators' "feet to the fire" until they fulfill the public mandate. And if they get some of the details wrong in the first implementation, well than we can continue through the process of refining and perfecting a system that can fulfill this need of all our people. Arguing about financial plan details now, is arranging the Titanic’s deck chairs as this ship which is our collective responsibility sinks, taking with it some 22,500 innocent lives annually.
The article "Change in Challenging Times: A Plan For Extending And Improving Health Coverage" may still be available from Health Affairs for the general public CLICK HERE .
See list of recent editorials CLICK HERE
Write to the authors CLICK HERE.
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