Universal coverage: Why not now?

By Herbert Kresh, M.D.

Almost every industrial country in the world has some form or variation of universal medical coverage — England, France, Germany, Canada, Australia, Scandinavia and Japan, to mention a few. Why doesn’t the United States have such a system? Is it really necessary, and is it workable and affordable? Would it improve and repair our chaotic and confused health care system and be beneficial to our country?

We have 45 million people who have no health insurance at all and countless millions with insurance that doesn’t offer reasonable coverage, so the need is real and urgent. In this country, we already have several federal medical systems that are functional, such as the Veterans Administration hospitals, Medicare, Medicaid, public hospitals and the Indian Health Service. These systems give us a practical working start on the problem.

As far as affordability goes, our current system is plagued with inefficiencies and duplications that waste untold amounts of money. Our hospitals compete to see which can be the most advanced and glamorous instead of providing a standard of excellent care for all.

In a universal coverage model, existing hospitals, clinics and insurance companies could still be run by the private sector, but with governmental supervision as far as profits and standards are concerned. Of course, we would have to be careful of excessive, complicated regulations so that we are not flooded with a morass of unnecessary rules. Certainly we can figure out a less cumbersome way of taking care of our medical problems than the chaotic method we have now. The move to a single-payer system with standard claim forms could save enough money to cover those millions presently uninsured. It would eliminate the “paper hassle” doctors bitterly complain of and avoid the multitude of different requirements that the various insurers have.

Today we have thousands of insurance companies, hospitals, HMOs, PPOs, etc., each with their own forms, regulations and requirements. These companies are in business to make a profit. Frequently their executives earn inordinate salaries while they cut benefits and services to their unfortunate policyholders. Adequate medical care should be essentially a human right, like food and housing. This nation is rich enough and smart enough to offer all of its citizens good medical care.

It is possible to have a two-tiered universal coverage system. If you like fancy, doting medical care with all the icing on it, and if you can afford it, go for it. But for everyone else, excellent care should be available in a democratic way and not in a caste-like system. Medical attention and health should be a commonality and service, not a business. The profit motive can be eliminated and a more caring attitude can be preserved and nurtured. We have some of the world’s finest hospitals and research institutes, but we also have barren areas with little or no medical services or facilities available. As a result, our health statistics, like infant mortality and longevity of population, are worse than many countries that spend considerably less for their health care. In other words, we are not getting our money’s worth!

Why don’t we have reasonable, compassionate, capable medical plans now? For one thing, there is a good deal of inertia and resistance to change by the established interests, namely the pharmaceutical and insurance companies. They have exceedingly effective lobbies and friends in Congress. What we need is a gradual, incremental change in our health thinking and philosophy. It can and will be done. Public interest and outcry, enlightenment, demand and need will do the trick. This nation has the people and brains to make a new system work for us and it will improve our country enormously. We can make it work.

Herbert Kresh, M.D., is a family physician in Dallas, Texas.