What’s Universal about Universal Health Care?

Putting aside any judgments about the bill itself, I have to wonder why politicians insist on branding the current health care legislation as “universal” in scope. Clearly there are no attempts within the bill to provide health care for every human being on the planet. Not only is the coverage of people markedly less than universal, not all treatments will be covered either. I find it puzzling that we so readily overlook these facts. Why don’t we hear more about this, and why was the name choosen in the first place?

One simple answer is that the term “universal” sidesteps political non-starters, such as “nationalized” health care, or even worse the pejorative “socialized” medicine. But this isn’t enough to explain why the name is trying to project an inclusiveness that the actual bill does not possess. I believe that the disconnect between what the bill actually accomplishes and what supporters would like to think the bill accomplishes points to an important aspect of the psychology of altruism. We all want to feel as though we have completed our moral duties to other people, and a significant subset of us believe that providing health care is a part of this. The bill certainly excludes certain people and treatments, but we don’t like being reminded about the limits of our generosity. By calling health care “universal” we are actively trying to ignore those parts of the bill that are decidedly not universal. It’s about politics, not policy.



~ by danplechaty on December 29, 2009.

7 Responses to “What’s Universal about Universal Health Care?”

  1. I always say “help those that are willing to help their selves”. Universal will never be universal until ALL people want the same thing, and clearly they do not. Someone always seems to lose out. Nice post. Alright … I think I have commented enough. Loving the blog so far. I will stay tuned.

  2. Sorry, but I don’t think this is a relevant issue. It’s about semantics, not the substance of the bill, which is what we should really be debating. You say pot-ay-to, I say pot-ah-to.

    When you talk about the “universal” nature of a health care system (“Clearly there are no attempts within the bill to provide health care for every human being on the planet. Not only is the coverage of people markedly less than universal, not all treatments will be covered either.”). I think you are using the wrong definition of universal. The word universal, here, implies specific to a political region (#8 on dictionary.com). If we are talking about the United States Congress, then we are talking about a bill that pertains to the United States’ citizens. I think the word “infinitesimal” more appropriately defines the health care system that you describe.

    With that being said, I really do believe its fair to consider the legislation being developed as universal health care. On the contrary, you say, “I have to wonder why politicians insist on branding the current health care legislation as ‘universal’ in scope.”

    I realize that the definition of universal health care isn’t very clear. But the most ‘universal’, if you will, definition is a health care system in which all legal citizens have access to health care. Right now our health care system is comprised of health care offered by private providers which accept payments from three sources: out of the pocket, government programs (medicare/caid), and private insurance. What most Americans don’t realize is that everyone in the nation has access to health care. Yes that is right, the status quo in America is universal health care. I mean you can’t just walk up and demand any surgery or free prescription, but the vast majority of Americans have access to health care through private insurance, out of pocket payments, or Medicare/caid. If they don’t through any of those, all they have to do is go to an Emergency Room and they can be seen for basically anything, emergency or not, regardless of their ability to pay for it.

    Don’t believe me? If so, you haven’t read a piece of legislation called the Emergency Medical Treatment and Active Labor Act. (summary from wikipedia) It requires hospitals and ambulatory services to provide care to anyone needing emergency health care treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment. I’ve seen how this works first hand. I had an internship at an inner city hospital in the Emergency Department. People would come in with a cold because they don’t have access to a primary care physician and if they didn’t have the money to pay or if they were an undocumented immigrant or homeless person, the hospital by law had to keep them, treat them, and pay for them. If they don’t have any coverage, not even Medicare/caid, then who pays for it? —->The hospital.
    But really is any good free? (good old Andacht) NO! So what happens is that cost is tacked on to everyone else who uses the Emergency Room / hospital. So to keep things simple. Let’s say an Emergency Room sees 10 people over the course of a budget period. All of them have an infection in their throat that causes them to have difficulty breathing. This is a simple procedure for the hospital and costs $100 in total. 3 of the patients have no coverage at all, 3 have Medicaid, 3 have private insurance, and 1 pays out of pocket. So do they all pay $100? No. Those with no coverage will pay $0 x 3, Medicare will pay $86.96 x 3, Insurance companies will pay 3 x $173.91, and the person who paid out of their pocket will pay $217.19. Why? The nominal cost is pumped up to $217.19. Insurance companies make agreements with hospitals to pay something around 80% of nominal costs, medicare is usually around 40%, and out of pocket, well you pay the nominal cost.

    So is it any surprise that the annual per capita expenditure on health in the US is $7,200 and the second highest in the world is Canada at $3,900 per capita per year.

    So do I really believe there is universal health care in the United States, right now? Yes, everyone has access to health care as long as you are willing to wait in the E.D. long enough you will get treated regardless of your ability to pay. Now does everyone have access to prescription drugs? Or every single possible element of health care? No, so I guess you could consider the status quo as being pseudo universal, but perhaps the current legislation will close that gap and make us closer to universal.

    The fact of the matter is, the WHO as well a variety of other sources considers the United States to be the only industrialized nation without universal health care. (“Sources: NAO (2003a), International Health Comparisons”, http://www.euro.who.int/document/e85400.pdf , and even wikipedia)

    Well, I contend that WHO is wrong and that we do have a form of universal care as well. Switzerland’s health care system is classified as being universal, when the vast majority of their citizens pay for heath care through private insurance just like we do. They have a security blanket for those who can’t pay for health insurance so everyone has “access” to health care. We spend more money per person than any other nation in the world on health care, at 16% of our GDP. Now when we take out the private sector and look at health expenditures in general, the United States spends a greater percentage of government revenue on health than any other industrialized nation in the world – 18.5% .

    My solutions are listed below.

  3. So my solutions to offer:
    The democrats’ bills being proposed don’t work to change the system very well. They work to tweak the system a little, then increase the level of access for a lot of people to this completely messed up system. This won’t reduce the amount of money Americans spend on health care.

    The first and most important thing we need to do to fix our health care system is detach health care from employee benefits. This is basically a tax loophole that was designed to have more money spent in the health care sector. Detach it. Our biggest problem right now is the lack of preventative care. The only reason the bills are believed to be budget neutral is because they slam preventative care requirements onto private insurers (and claim that increased preventative care will reduce health care expenditures by 40%). This is just like trying to fix something with another piece of patchwork. This isn’t stable and it doesn’t make sense. Preventative care saves money down the road, the problem is since people change jobs so much, their health insurance changes. The average length of time a person will keep their health insurance is under 10 years. So health insurance companies know that and say hey, why should I invest in preventative care when its going to cost me (the insurance company) $100 now and its going to save the other insurance company (my competition) $5,000 20 years from now. This is where capitalism falls short, but it doesn’t mean that we need to turn to the government to take over here. It means that we need to simply take health care off of employee benefits. If people buy into a health insurance plan and stick with it for the long hall, capitalism takes care of everything. It says if we want to save $5,000 20 years from now let’s pay $100 right now (this might be to have someone quit smoking or investment in a vaccine). One might assert this is what the public option aims to achieve. That is true, but I believe that a competitive market place will offer the best prices and most involved commitment to minimizing the cost a person will spend on health care.

    Second most important is the need for electronic medical records (EMR). I think this could save so much money. Imagine a business communicating only through direct conversation or mail. E-mails, phone calls, file attachments, computers, etc. make things SO much more efficient. The biggest financial benefit of EMR (Newt Gingrich talks about this a lot if you want to learn more) is the fact that advanced directives / medical will would be on EMR. So many doctors have to spend millions of dollars keeping people alive that would rather be dead because they have to be conservative and defensive when making assumptions about their advanced directives. He mentioned a hospital in La Crosse, WI that saved so much money compared to basically every other hospital because they had advanced directives on electronic record and they could be easily accessed. Its something like one-third of a person’s lifetime expenditure on heath care is in the last 6 months of life. That can be reduced quite a bit if we eliminate the part that they don’t even want to go through (even if is free for them).
    Not to mention, the potential research benefit from EMR is absolutely insane. I think that with an efficient system of medical records, we could do 30 years worth of clinical research in one year.

    Third: TORT reform. When a surgeon pays more for malpractice insurance than triple the average person’s salary, it’s no surprise that it’s going to cost through the roof for any surgery. But we can’t just wipe out malpractice cases. They keep surgeons honest and when there’s thousands of dollars on the line, the doctors are motivated to avoid trying to rush through seeing as many patients as possible and a great emphasis is placed on quality rather than quantity. But we have to realize that surgeons are going to make mistakes every once in a blue moon. Simple solution: reduce the amount of money that patients can run away with in malpractice cases, charge fees for patients who try to pursue these cases to prevent stupid cases that still have to be seen in court and still cost money for the surgeons (hence raise the price of malpractice insurance and thereby the cost of every surgery)

    Fourth: Obesity, Obesity, Obesity. The cost obesity has on our health care costs is outrageous. Not only does it lead to almost every disease imaginable, but it requires increased cost on care. Private or Public, no health care system can help us reduce our expenditures on health care to the level of any other nation when we are so FAT! A lot of this is because our diets are skewed and lack the proper balance needed. We need to be consuming more calories from whole grains and complex carbs. My proposed reforms mentioned first with regards to insurance companies spending more on preventative care should help reduce the level of obesity. I would like to see at a national level, a tax on fats and sugar. Every single food legally sold, no matter where, is required by law to have nutrition facts. Every single gram of saturated fat is $0.10 and every single gram of unsaturated fat is $0.01. Sugar is $0.001 per gram. Revenue will be used to fund research to prevent and reduce obesity. At the local level, I would like to see community recreation centers. We have libraries, why not have a community gym? Membership rates would require local citizenship and a small membership fee perhaps $10 a month with a sliding fee for those below certain income levels.

    Fifth, I would like to see increased levels of coverage for youths and students at the national level. I think there is a higher level of social/public responsibility than personal responsibility when it comes to youths and students. But after you’re a student, I think personal responsibility is significantly more important up until medicare sets in at 65. Health Care isn’t a human right and never should be. It is the responsibility of the government to create “an “adequate environment” for people to have the highest attainable state of physical, mental, and emotional well-being. If people are fully capable and functional human beings and the government invests over a hundred thousand dollars on their education, then I think that environment has been created. If the individuals are handicapped or for some reason are simply incapable of providing for themselves, then yes it is fine that the government steps in.

    Lastly, I would like to see increased access to primary care for the under and uninsured. This can be achieved through stratifying primary care quality. Right now a lot of people can’t afford to get the primary care needed. Well that’s probably because right now there’s only the “Lexus” option available. What’s wrong with offering up the “Toyota” or “Scion” levels of primary care. Regulations in primary care can lax in certain areas to decrease costs and the increased use of a nurse, nurse practitioner, or physician assistant with oversight from a physician could help reduce the cost of primary care.
    I haven’t seen anything similar to my proposals offered by Congress, but The Patient Care Act proposed by Republican Paul Ryan from WI seems to be the best I have seen so far. Some other proposals come close, but rely too much on funding by taxing the wealthy, who already bear a large burden of our health care costs.

  4. I like this BLOG though chetty. Is there anyway I could have a guest posting? I have some interesting topics I would love to write about.

    By the way, if you see Obama near campus, do me a favor. Stop him, let him know next time someone tries to bomb an airplane with almost 300 people on it, and he has to make a speech about it, make sure he wears a tie. I mean he can do the bow tie thing and get that professor look going or whatever, but I mean there’s a time to be casual and a time to be serious and your dress should reflect that. If we can show up to NHS induction ceremonies in ties, I think he can make a speech to a concerned body of people with one. Keep it classy America,


  5. 1. I tried to make it clear from the beginning that I wasn’t going to talk about the bill itself. But your post on that was interesting.

    2. Yes, we have mandated emergency care. No, I don’t think this means we have universal health care.

    3. When you talk about picking the definition of “universal” that we’re using, I think you’re getting to the heart of the manner. If the bill is only universal in a very limited sense of the word, people who want it to be more broadly universal can still try and claim a moral victory through semantics and a little bit of self-deception.

  6. Also if you want to guest post, let Lindsay and I know what it would be about. I should say though that this won’t be a very political blog; even if we touch on political topics, it will focus more on economics and communication. Maybe the first couple posts aren’t representative of that, but we’re going to try not to get into debates where there is a clear left/right divide.

  7. Brian, I really enjoyed reading your comments. If you have topics in mind that relate to globalization (perhaps in the arena of health care since that seems to be an area of expertise for you) we’d love to host you as a guest contributor! Just let us know once you have a topic in mind.

    Also, I noticed and disapproved of the Obama absent-tie look as well!


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