Universal Healthcare Back on the Table
One of my pet peeves is people referring to universal healthcare coverage as "free," as if it's oxygen in the atmosphere. Someone's always paying for it. It has happened on a few occasions in our magazine. The first time was several years ago in an article about a delegation of nurses who visited Cuba to learn about that country's "free" healthcare system. Perhaps I was the only one who saw irony in that reference.
Another irony is how we spend more on healthcare than any other nation, yet don't enjoy the best outcomes across the board. Costs are spiraling, and it's estimated we'll be spending 20 percent of the gross domestic product on healthcare by 2016, up from about 15 percent today.
We can't stay on this path. Is taxpayer-funded universal healthcare the answer to curb runaway spending? After a long absence from mainstream political discussion, it's back on the table. While anathema among Republican presidential candidates, universal health plans have been proposed by some Democratic contenders.
In the Jan. 1, 2008, issue of Annals of Internal Medicine, the American College of Physicians publishes a position paper that urges universal healthcare insurance coverage so "all residents have equitable access to appropriate health care without unreasonable financial barriers." The recommendation is based on a study of the healthcare systems in 12 industrialized nations. The group offers pros and cons of a single-payer system, where the government pays all costs, versus a pluralistic system that combines the government and private entities.
I'm leery of putting my healthcare in the hands of politicians, and also skeptical of government's ability to find huge administrative efficiencies and reduce costs, so I'm closer to accepting a pluralistic model if it comes to that. However, rather than covering all healthcare costs for everyone, which inevitably leads to rationing, it makes more sense to create a program that universally covers catastrophic and chronic conditions. Those are the cases universal healthcare advocates often cite when they make their case, and those situations could be addressed without nationalizing healthcare.
While the universal healthcare debate continues, we should explore policy options advanced in "Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending" a report issued Dec. 18 by the Commonwealth Fund Commission on a High Performance Health System. Key among them is the creation of a national public-private center for medical effectiveness and healthcare decision-making, which would evaluate the cost-effectiveness of new treatments and technology. Other recommendations include promoting information technology, reducing tobacco use and obesity, establishing hospital pay-for-performance programs, and paying doctors and hospitals per episode of care instead of for each service. Total savings are estimated at $1.5 trillion over 10 years if all recommendations are enacted.
You're on the front lines of healthcare and are in the best position to know what's wrong and where we should go from here. Whatever your views, make sure they're heard by those seeking your vote.