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Doctors Debate Universal Health Care: Pros and Cons From the Experts Is universal health care right for the United States? |
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 One of the top issues on your mind this year is likely to be health care. Buzz word: universal.
“Health insurance is expensive, and not everyone can afford it,” goes one argument. "The government should provide everyone with access to paid-for health care.” “That's not fair," goes the other. “For example, why should everyone have to pay for people who choose not to take care of themselves, such as smokers?” And the debate rages on, with many more pros and cons, facts and figures and ideologies making the details of each argument downright interesting and utterly important.
We asked two doctors with strong opinions on the topic to share their side. Here’s what they had to say. You can get in on the debate here . (Scroll down to "Debates!")
FOR How can there be a debate over whether universal health care is itself a desirable goal? A 2002 Institutes of Medicine study concluded that more than 18,000 Americans die every year because they’re uninsured. Some kind of health coverage for every citizen would mean fewer child deaths from asthma, fewer cancer deaths in minority communities and fewer veterans who depend on emergency rooms for their primary care. The real questions are how universal care would be paid for and who would decide levels of reimbursement.
Health insurance companies spend heavily to condemn something called “socialized medicine,” recognizing that any single-payer plan would likely result in heavy losses for their industry. But no major organizations or national political figures have advocated creating a system like Great Britain’s, where the government owns all the facilities and employs all the doctors and nurses. Two other myths about universal care are that doctors oppose it and that quality of care would suffer. But a plurality of physicians, particularly primary-care doctors, supports national health insurance. And there is now strong evidence that, even in developed countries with addiction problems like ours, universal coverage correlates with improved quality of health across the socioeconomic spectrum. AGAINST
America is often criticized for its lack of a universal health-care system comparable to the Europeans and Canadians, even though Germany, the United Kingdom and even Canada are increasingly turning to the private sector in order to relieve the financial burden on government and solve serious delivery problems, most notably “rationing by queue,” the prolonged wait times for many services, including cancer treatment and cardiac surgery. Compared to the private sector, government programs are inefficient and the higher costs have to be paid for with higher taxes or spending cuts in other areas such as defense, education, or even medical research and development. This is a tradeoff that most Americans would not be willing to make. If low-income persons find health-care coverage unaffordable, they should be subsidized by the government, but they should retain ultimate ownership of their health-care resources and the choice about how those resources will be utilized. Such patient ownership and choice will create the demand for price and quality transparency necessary to make value-based health-care decisions.
The fundamental flaw in universal health-care systems is a misplacement of incentives. The decisions that drive health-care costs and quality of care are made by individual patients and their health-care providers. These decisions should not be influenced by universal government mandates, administered pricing systems or expenditure targets, but should instead be based on an adequately informed assessment by individual patients and their providers about the value of services in a particular clinical situation.
Last updated and/or approved: March 2008. Original article appeared in Jan/Feb 2008 issue.
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BAH HUMBUG
written by John , January 05, 2009 universal health care is overrated. most of the doctors i have personally spoken with have cringed at even the thought of UHC. It would mean more taxes(even for people who dont need it), you would have long waiting periods to even get in, also doctors will be limited on the amount of patients they can see. it hurts us. please help me
written by Stephanie , December 30, 2008 where should i go i have so many Question for example -would it make diagnosis and treatment easier for doctors -would doctor focus on doing what´s best for their patients Suggestion - The education model for healthcare
written by physyko , December 28, 2008 Universal healthcare and socialized medicine tend to be extremely polarizing terms. The fact is that the whole world is moving to what we call the "Education" model of healthcare. Educators like to say there are three types of education: public, private and parochial. Although of course parochial is but a segment of private. In healthcare this translates to a public safety net, a private medical industrial complex and the alternative medicine market. The reality is that today no-one not in Canada, not in the UK, can stop a wealthy individual from accessing private healthcare. All those individuals do is get on a plane. The reality is that the US already has the beginnings of a public health safety net in the form of Children's Services Programs and Medicare/Medical. All that needs to be done in the US is for these programs to be expanded to allow anyone who so chooses to partake of them. Anyone who wants to continue with their existing private program should be able to. And of course the increasing numbers of people that for various reasons including beliefs and price point chooses to use alternative medicine will continue to do so. Although it doesn't appear like we are going in the right direction, we actually are. We just need to expand existing programs to cover everyone. Fortunately the additional funding necessary to expand coverage is not that great as there will be significant savings by eliminating the existing system overhead administrative and marketing costs. Why have we never seen a country with socialized medicine go back to free market medicine like ours?
written by Daniel McGraw , December 15, 2008 I think my title says it all. I can not find one instance where a country with socialized medicine has returned to a free market insurance controlled medicine like the U.S. has. Can it be that the citizens of the countries with socialized medicine actually like it? it takes a lot of ppl to create prosperity but only a hand full of bad ppl to ruin it
written by anonymous , December 13, 2008 There will always be greedy, corrupted, power hungry people out there who will emphasize the cons of everything to stay in power. ...
written by Jordan , December 12, 2008 I want you all to look at countries like Costa Rica, Italy, and the UK. All 3 have great universal health care systems that work. Do a little bit more research and then you can get on your soap box and complain about a universal health care system. However, I think you will find that you will actually be on the other side of the argument. n/a
written by Bob , December 11, 2008 CRAP!!!!!!!!!!!!!!!!!!!!!!!!!!! the goverment blows
written by john smith , December 02, 2008 this is one of the most retartedideas ever Government is not the answer, it is the problem
written by Austin , December 01, 2008 Give me one government program that has effectively worked. Abuse of the system, rationing, and long waiting lists will surely take place. The idea of government bureaucrats having control over my health doesnt exactly feel all that great. Also, if we get a government-run health care system, where will all the Canadians and Brits go for their healthcare? Whatever happened to the notion of individuals taking care of themselves and instead relying on the clowns in Congress which have given them nothing, over and over again? As an 18 year old, I cant wait to see the politicians experiment their proposed health care plans upon us. Unthinkable
written by Matt G. , November 25, 2008 How do you people expect the government to be able to run a complex system like health care? When was the last time you went to the DMV? I know when most people go into the DMV just to take a picture it takes half an hour. What do you think the healthcare system will be like. Too many people already abuse the healthcare system, when it becomes available for all, all will abuse it. The people that abuse healthcare outweigh the people that do not seek medical treatment. I know I want to pay an extra few grand to see some people abuse government spending and my money. Instead of all these people spending their money on useless stuff, tell them to plan ahead for a couple of years and you will be fine. Get a job, and support yourself. Man up, and stop living on other's expenses. ...
written by sami , November 21, 2008 I am all for the universal health care system for the U.S. It's ridiculous how some people avoid going to the doctors even when they are in serious conditions. You shouldn't be worried to get treatment because you cannot afford the fees. Health care should be available to all american citizens. A single payer universal health care system would not be considered socialized medicine. I think this is not hard to decide. It hurts when you hear about people that are sick and dying just because they don't want to be paying off medical fees from 5 years ago or more. Is it Good? Is it Bad? How do you stop abusers?
written by Kathy , November 20, 2008 I work in a small hospital that mainly provids health care to the needy. Even though most of these patients can afford their alcohol, drugs, and cigarettes, they can not afford health insurance. Most do not work - per their choice. They use the emergency doctors as if they are their family doctor. Excuses I hear are many. They get great peronsonal care, free tests, free meds - of course they are upset when it is not a narcotic. Some are very demanding and threatening to the staff. We have many illegal immigrants who come in and often forget what name they gave when walking in the door. They receive free hospitalization. Funny that most claim they can not speak english but yet forgets when talking with a american friend. Hmmmm I wonder how this univeral healthcare is really going to work. We already have abusers of the services already provided. So I am wondering if this program is really going to be beneficial for those who have a responsible, moral, life. As for the insurance companies charging huge fees, I can honestly say that it is a rip off. I am paying for insurance that the majority of I will never use. For example: I do no plan are having anymore babies. So, why can't I just pay for insurance that I would use? That is formed just for me. The $300 dollars I pay per month I could use. So if Universal Insurance will be for everyone, why not! I'm All For It
written by Sara , November 20, 2008 I think it's pretty ridiculous how people are dying every day just because they don't have enough money. People are avoiding going to the hospital when they don't think that they can afford it, and I think our government needs to step up and help the people of the United States. People need to go to the doctor for regular check-ups, and it's just wrong when it gets to the point where people can't even afford to do that anymore universal health care with a difference!
written by sara , November 16, 2008 I agree that universal health care should come into effect. i believe our medicine system and cost of treatment are over hyped.Most of the insurance companies and hospital systems take over 3-4 times the real cost of treatment from the insured patients anyway, firstly to make profit and to offset the loses from uninsured and homeless people. so who is paying extra ! We the people who are insured. second point-why should the hard working class suffer when an unxpected event like cancer etc leads them to disability when most of their life they were making the country grow. should we give an example to the world that america is a great country for only for the rich or healthy or young peolpe who are active. lastly we should acheive universal health care by bringing the over hyped cost of the health care system down and at the same time work on decresing the so called possible long wait for physician down close to our current system and take the good of all health care systems in the world. SOunds idealistic but not impossible Healthcare in the US - a personal story
written by Tim Davis , November 04, 2008 I own my own business and I am the only employee of that business. If the work doesn't get done, no money comes in. That's the chance you take when you work for yourself. A given. In the US, when an illness strikes it can bankrupt you and your business and you lose everything you've worked for. That's what happened to me. Last December, I became mentally and physically disabled from a debilitating condition. Then name of that condition that still afflicts me is still unknown. Why? Because I have no health insurance and there is no help from the government. I saw a psychiatrist for a few months running up huge medical bills until the point where I could no longer pay. When I could no longer pay I was cut off. The doctor just gave me a medicine cocktail and changed it when it didn't work. No tests were run, just here take this medicine that costs $500 a month, which didn't work and just made things worse. After I was no longer able to see my doctor, it was recommended to go to the free health clinic where I was turned away and not allowed to see a doctor because I owned my own house and was educated and according to the social workers, I should be able to find my own resources. I was told by one social worker that they had no time for me because they were getting ready for an audit and others who had children needed more help than I did. A couple months later I attempted suicide after losing my life savings. Now I'm losing my home. I did everything from contacting my Congressmen to calling the head of the Health and Human Services for the state. There was no help for someone in my position. I am still sick and do not have the means to support myself and still there is no help. To be eligible for Social Security disability benefits you have to be disabled for two years first. A person will starve to death before that happens. This is supposed to be a country where someone can work hard and get ahead. But without healthcare for everyone, it becomes a country for only the rich and insured and the middle-class is being wiped out. I am told that this is a "christian" nation, however, it doesn't act christ like. According to the bible, jesus cared for the sick, the poor and the down trodden. If this country wants to boast to be a christian nation, it needs to act accordingly. But this nation is not doing that. There is nothing christ like about this nation, but filled with hypocrites. Until there is equal healthcare for all, this nation will be filled with people who make decisions whether to pay for their prescriptions this month or pay for food. The homeless rate will continue to rise as Washington bails out the rich and let the people who fall ill, fall into bankruptcy and poverty never to return. So I tell you, if you call yourself a christian, act like it and help care for the sick and the poor. But apparently you so-called christians are too concerned for the life of a mass of tissue that isn't a person to care for the actual people who need help. I assure you I will not pay one cent of income tax in this country until there is healthcare for all and not just for the rich and the very poor, leaving out the people who built this nation - the middle class. My only chance of survival is gather enough money to leave this country and move to a country that has universal healthcare, where I can find out what's wrong with me and start treatment for whatever it is that ails me where I can return to work or re-start my business. It's either that or stay here and die in the streets. Great country eh? ABSOLUTELY NOT
written by Melissa , November 03, 2008 Why would anyone want universal health care. Universal health care would decrease the quality of care provided to americans! Plus what incentive does that give any person to go through rigorous schooling to become a doctor or a nurse?? The government is supposed to be hands off!! Not hands on! If the governement controls health care and something goes wrong who is going to correct it. Certaintly not the government. Slightly frustrated..
written by Alaina , October 24, 2008 In the U.S., we already have socialized services: the police, fire department, public schooling, and others. I rarely hear people complain that their tax dollars are being spent on these services. It would be atrocious if someone were to say "well I don't want MY tax dollars being spent to help put a fire out at someone ELSE'S home. How is it helping ME?" We would immediatly excuse them as socially insensitive. So why is this okay to say when one's tax dollars are being spent to help alleviate someone's cancer, prevent childhood obesity, and save lives? It is simply a selfish way to view the healthcare system, and it absolutely aggrevates me. ...
written by James Hubbard, M.D., M.P.H. , October 20, 2008 Thanks Megan. It's good to get the views from people that use the system. I vote NO!!
written by Megan , October 18, 2008 I have done so much research on this topic, it's kind of ridiculous! As an American, I would NOT ever vote to have universal healthcare! Along with the research I've done to come to this conclusion, I have many friends that live and have lived in Canada, where we all know UHC is implemented. Not one of them is a fan. In fact, 4 of these people have moved to the US to get away from the system. I guess when they're sick, they actually like to be seen in a timely manner instead of being miserable for months. Who knew? Great Aritcle! Thanks! ...
written by James Hubbard, M.D., M.P.H, , September 10, 2008 Thanks for the comments and perspective, Christine. Glad you like the website. I Wouldn't Trade
written by Christine , September 10, 2008 Given the option to trade our Canadian system for the American system...my answer would be a resounding NO! Seriously...I don't know what everybody is afraid of down south of the border. Also...don't you know about the propensity of Canadians to whine? BTW...Great website! ...
written by James Hubbard, M.D., M.P.H. , August 28, 2008 Many people have those same fears, Nell. I hope the "powers" can get together to find a good, acceptable solution, that does not cause additional problems. Thanks for the comments. Not Where We Should Start
written by Nell , August 27, 2008 There needs to be an overhaul of the insurance companies - no doubt about it. But I don't believe that socialized health care is where we should start. Heck, I'm insured through my husband and it doesn't mean we could afford all the costs of a health crisis simply because we have insurance. "Socialized" medicine is not the bogeyman
written by Lea , June 29, 2008 For the perspective of a man who was a physician throughout the period of the NHS in the UK and who is appalled that this public service is being "privatized" to enrich (primarily foreign) buinessmen at the expense of the UK and its public's health, please see The Political Economy of Healthcare: A Clinical Perspective, by Julian Tudor Hart. The current and past level of debate about universal healthcare is bogeyman talk, meant to scare children into blind acceptance of the industrialization of healthcare. Healthcare costs what it costs, and it costs more when 30% overhead is required to administer it profitably. I have to take issue with this statement: "Compared to the private sector, government programs are inefficient and the higher costs have to be paid for with higher taxes or spending cuts in other areas such as defense, education, or even medical research and development. This is a tradeoff that most Americans would not be willing to make." From the book cited above, citing data from the OECD, Western European systems that cover everyone spend 8-9% of GDP on healthcare, while the US was spending 15% to *not* cover everyone (back then, and I understand that we're passing 16% now). This is the trade-off that Americans actually are making. Respectfully, Dr. O'Shea, "adequately informed assessment by individual patients and their providers about the value of services in a particular clinical situation" would be great, but isn't any more likely to happen now (when a physician has to see a half-dozen or more patients per hour to break even) than it would be in an NHS-type system. I agree, however, that coverage does not equal access. Providing everyone with health insurance will just make the health insurance companies richer, despite their cries of "don't throw me into the briar patch." We need to provide everyone with health care itself. Glad you liked it!
written by Leigh Ann , April 24, 2008 Thanks, Sandy. Glad you liked the article! We're always interested in what readers want to see debated, as well, so please suggest away if you'd like! (Our current issue covers on-demand C-sections, and we have two abortion debates planned.) Thanks so much for commenting. To Your Health, Leigh Ann Hubbard Managing Editor James Hubbard's My Family Doctor Presidential Healthcare Debate Discussion
written by Sandy Richardson , April 20, 2008 Thanks for this article and your website. I'ts too bad we get such little detail in the presidential debates to really understand these important issues as voters. I like this format also and hope that others will reply to this type of discussion with thier opinions and other relevant facts. Write comment
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