Thursday, November 03, 2005

We Need Universal Health Care: A One-Payer System

Data released today by the Census Bureau show that the number of uninsured Americans stood at 45.8 million in 2004, an increase of 800,000 people over the number uninsured in 2003 (45.0 million). The number of uninsured Americans was at an all-time high in 2004.
Center on Budget and Policy Priorities

The aims of a good health care system can be easily stated. We want the best care we can afford efficiently delivered in a system that covers everyone and allows as much freedom of choice for doctors and patients as possible.

Dependence on the free market works fine for those who have enough money to afford it but is disastrous for the poor. The notion that supply and demand will guarantee efficiency, high quality, and low cost while maximizing freedom has fundamental flaws.

We need to go further away from a market system not toward it. No alternative is perfect, but we can do much better than we are doing now. I urge a one-payer system something like that now found in Canada and that is approved overwhelmingly both by Canadian citizens and doctors. The plan would be paid for by progressive taxation that would secure a level of quality care that was as high as possible given all our other social goals and values.

Some compromise would have be made between medical needs and expanding costs in relation to the availability of resources that always remain finite even in a rich country. This is not socialized medicine in which medical professions are paid by the government but socialized insurance. The advantages are:

1. It would be universal. It covers everyone regardless of income, pre-existing conditions, or employment status.

2. It would be comprehensive. It includes treatment by doctors and hospitals for all necessary medical services including prescription drugs, mental health, dental problems, and long-term nursing home care.

3. It would be efficient. Enormous savings would result in the reduction of administrative costs by having one uniform system of accounting. Because of the volume involved, the government as sole administrator could put constraints on costs of supplies and services. Money that now goes into investor profits could be used to treat sick people.

4. It would produce outcomes on the whole that are better than we get with the present system. The Canadian system supports this claim, although cross-country comparisons are hazardous.

5. It would preserve a great deal of freedom for doctors and patients. Patients could choose their own doctors and hospitals. Doctors could prescribe tests, treatments, and drugs with no greater constraints than now operate through HMOs, other insurance plans, and the ability of the patient to pay.

A universal health plan would, of course, not be free from problems, complications, and frustrations. Upward cost pressures will occur as they do now due to the creation of new and expensive drugs and technologies, the rising demand for them, and the increasing number of the elderly. We could expect fraud, abuse, and waste but not necessarily any more than we already have, except for the fact that some people seem to delight especially in cheating the government. Bureaucratic procedures and decisions would drive us nuts as they do now with HMO’s and other insurance plans. Some restriction of services would be necessary, but we have rationing at the present based on income. Limitations in the one-payer system ideally would be based on rational considerations relating to cost constraints that would not discriminate against the poor.

(This material is taken from my book, The Ethics of Belief (Lima: CSS Publishing Co., 2001), vol. 2, 119-24. )

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