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BY RASA PETRAUSKAITE

In print | November 8, 2007

In the general election of November 2008, a question critical to the welfare of the country is likely to hang in the balance. With a Democratic win, the prospects of implementing a universal health care system of high quality and convenience in the U.S. will become brighter. The National Coalition on Health Care says that our health care system is “riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management and inappropriate care, waste and fraud.” What bothers me most is that not all U.S. citizens, let alone residents, can afford to have surgery or a medical examination. The U.S. should adopt a universal health care system of the same quality and convenience as the one that operates now. Some people certainly disagree with me, but I would like to address some of their concerns in this article.

Universal health care of high quality and convenience arguably exists nowhere in the world. However, there is no reason (other than purely political) why it should not exist. In Britain, many complain that their universal health care system functions badly. The same complaint has been made in Canada and Scandinavia. The problems in Scandinavian countries stem from the fact that the governments there do not provide enough funding to hire a sufficient number of doctors. In some cases, patients have to wait several months before they can see a dentist or a physician. This is not how it should be in the U.S. The number of doctors employed in this country should rise rather than decline from the current level. Waiting periods for appointments longer than they are now are unacceptable.

Currently, about 40 million Americans live without health insurance. About 180 million pay for insurance through their employers, about 30 million purchase it on their own, and about 80 million have the government pay for it. This means that about 15 percent of U.S. citizens may not be able to afford surgery or medicine. Someone who lacks the necessary thousands of dollars in his savings and does not have health insurance may never have his cancerous tumor detected at an early stage — even though the technology exists.

Bush proposed some health care reforms in 2006, but none of them adequately address the problem. According to his plan, a family of four making $25,000 or less would be able to get a refundable tax credit of $3,000 from the federal government to help buy insurance. Single people or families of fewer than four would not qualify, however. Bush also proposed building over 800 community health centers in low-income areas. It remains unclear what services the community centers would provide, how high the quality of services would be and how much patients would have to pay for them. In short, Bush’s proposals did not include providing all Americans with health insurance.

Now on to a possible solution: a universal health care system that would make all Americans able to afford life-saving surgery and necessary medicine. It is possible to implement a universal health care system in the U.S. that would avoid such problems as the ones in Scandinavia. The new system would simply have to be just as good as the current one from the patient’s perspective. It is possible to design it so that it functions this way. The incentives of patients and doctors would have to be aligned to reduce economic inefficiencies, and additional funding would most likely be required.

An ideal universal health care system would provide incentives for patients to seek the best possible prices for the best possible services. This is why co-payments for seeing doctors should be preserved at the levels of the typical health plans that exist now. Similarly, today’s incentives for seeking generic alternatives to brand-name drugs should remain. I pay $20 to see a physician, and pay less for generic drugs than for branded products, which should not change.

The system should also preserve incentives for physicians to provide the best possible care. Patients should continue to be be able to choose which doctors they want to see. If a patient thinks that his doctor is incompetent, he should be able to switch without any penalty, the way he can do now. The new health care system should not be significantly more expensive than our current system. If more doctors and correspondingly fewer insurance company bureaucrats were employed in the U.S., then the universal medical system would cost the country approximately the same as the current exclusive system costs. I would much rather have more doctors around than private health insurance agents.

Another factor that critics of universal health care cite as problematic is the cost associated with maintaining high standards while serving the whole population. Basically, if more people were eligible to receive medical care in the U.S., it would possibly increase the demand for hospitals and doctors. To prevent this, the government would have to be prepared to fund a corresponding increase in supply. Furthermore, governmental infrastructures and personnel that do not exist now might need to be put in place. So, it is likely that a high quality universal care system would require additional funding, perhaps in the billions of dollars.

On the other hand, it is possible that a high quality universal health care system might turn out to be cheaper than the system operating now. If the corporate intermediaries, such as insurance companies, were eliminated from the health care equation, medical care would become cheaper for everyone. The U.S. is the only industrialized nation that relies on insurance companies to provide medical coverage. The country also spends about four times more on its health care system per capita than the average industrialized nation. While we cannot establish causality here, we can hardly find another explanation for such a staggering difference.

Also, it is possible that the demand for doctors and hospitals would decrease because more diseases such as cancer would be diagnosed earlier and treated less expensively, reducing government expenditure on Medicare. According to the American College of Physicians, the fact that many Americans do not have health insurance increases the financial burden for America as a whole. The uninsured do not get early detection of diseases, so they often become sick for prolonged periods and into their elderly years, or they become disabled. Early detection and treatment are often less expensive than treating diseases at more advanced stages. A universal health system would help some individuals avoid getting very sick. A Congressional Budget Office study found that if health care costs continued growing at the same rate over the next four decades as they did over the past four decades, federal spending on Medicare and Medicaid alone would rise to about 20 percent of gross domestic product by 2050. The U.S. GDP in 2008 was about $13.13 trillion. It would not run out of money even if it had to spend a trillion more dollars on medical care per year. The additional expenditure on medical care in the U.S. would be reasonable given the benefits.

Finally, research findings suggest that some of the high costs incurred by Americans for health care stem from the fact that the system is partially for-profit. The World Health Organization estimates that more than a fifth of all the payments for medical care in the U.S. covers administrative costs, which include income paid to insurance companies and to those who audit them. Administrative costs of for-profit hospitals are [about a third] higher than those of public and private non-profit hospitals by about a third. Thus the growth of for-profit insurance providers and hospitals in the U.S. has contributed to the growth of health care prices.

A superior universal health care system is worth implementing. Even if it seems more expensive than the existing system, the benefits would outweigh the costs and difficulties. The current system already costs 915 billion, but the price of the new system may actually be less than that. To further off-set the costs, the government could cut expenditure on other endeavors, such as some portion of the more than one trillion dollars spent on the Iraq war. What it boils down to is that everyone living in the U.S., the richest country in the world, should have access to superior and convenient medical care.

Rasa is a senior. You can reach her at rpetrau1@swarthmore.edu.

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