The Case for Universal Health Care

               In my previous post I laid out some of the issues with our health care system and attempted to propose a middle ground for a public option with a neutral board overseeing pricing negotiations.  In this post, I want to take the opportunity to argue for Universal Health Care.  I realize this is a strongly left position and one not often palatable to those on the right.  I may be a bit off here, but I think the biggest objections are rooted in two principles of the right:
1) General objection to any expansion of the federal government
2) General belief that the free-market will always provide better services than the government.
These two principles seem reasonable on the surface, but I think they fail under closer scrutiny.

               When it comes to health care, these two principles are intertwined and yet separate issues to be addressed.  I’ll start with the expansion of the federal government and work quickly into free-market issues.  There are several ways in which government is the primary provider of services to the public, most of them having to do with public safety and protecting the citizenry.  We all pay taxes to support our local police and sheriff departments, state police department, and the FBI.  All of these organizations are government entities designed to protect the welfare of the citizenry.  These services are considered essential to the public good.  I think most of us cringed when we read this story of a fire department deliberately watching a house burn.  It just seemed wrong.  Regardless of the issues behind it, the fire department came across as cold and callous.  The story violated our sense that the fire department is there to serve and protect us. 

               How does this relate the health care?  It comes down to viewing quality health care as a public safety issue.  Many communities in the U.S. have free vaccine clinics.  Why? Because studies show that getting vaccinated early can provide a lifetime of protection and not just for the vaccinated individuals.  There are individuals within our society who cannot get vaccines because of severe medical issues that leave them immune-compromised.  Vaccinating those who do not have a clear medical reason preventing it provides herd immunity to the vulnerable.  Visit vaccines.gov for more information.  Vaccines aren’t the only public safety aspect of health care.  Roughly 28 million Americans were uninsured at the end of 2015.  Those 28 million people have one place to go for care – the ER.  Probably the single most expensive entry point to the health care system.  And these people aren’t going for a simple case of the sniffles.  They’re going because they think it’s a heart attack or they’ve had a headache for 3 straight days that turns out to be an undiagnosed brain tumor.  These treatments are expensive and the hospital probably isn’t going to be able to collect on the full bill.  Either the hospital will settle the charges with the patient and write off the rest as a loss or the patient will file bankruptcy and the hospital will write off the uncollected balance as a loss. 

               In a free-market system, operating at a loss is simply unacceptable.  Companies must make a profit, and preferably a bigger one than last year.  (Note, it simply is not possible to continue to make larger profits year after year).  This is why hospitals (and, to a lesser extent, other companies) build in anticipated losses into the cost of their products and services.  Wal-Mart knows it is going to suffer some loss due to theft, bounced checks, food spoilage, etc.  Wal-Mart also needs to make a profit.  So, that t-shirt that cost $2 to make sells for $10.  Hospitals and the entire health care system do the same thing.  The difference is the cost.  Open heart surgery isn’t cheap.  A stay in an ICU ward for any length of time can add up real fast.  Pile on a similar mark-up in price and now that hospital visit that cost them $20k sees the patient getting billed $100k.  Yes, insurance will cover some of that, but even a typical 80/20 split leaves the patient on the hook for a $20k bill.  Sadly, most Americans don’t even have $1000 in savings, let alone $20000.  In fact, 1 in 3 Americans has no savings at all.  It’s pretty hard to pay for an unexpected stay in the hospital when you have no savings.  I don’t want to take away the need for individual responsibility, but without really understanding the reasons why Americans have little to no money saved up for emergencies, I find it hard to simply blame the problem on irresponsibility. 

               If we remove the free-market need for profit from the cost equation, imagine the change in what we pay.  In fact, change the entire dynamic to running health care as a non-profit government run charity.  In this scenario, costs are not overly inflated to cover expected losses.  Services are charges at, or just slightly above, cost.  Taking a loss because someone can’t pay isn’t a big deal because we aren’t worried about making a profit.  Assuming we use taxes to fund the health coverage (like we do for Medicare) then everyone is still paying something into the system.  The other advantage here is that consumers no longer have to play the game of trying to find an in-network provider.  Anyone who has ever had any long-term illness or needed emergency care knows the challenges in finding an in-network provider outside your normal locale.  If I’m traveling someplace, I actually check to see where in-network providers are before leaving.  Not too onerous if I’m staying in Indiana, but it gets to be a real pain if I am traveling out of state.

               In the end it really comes down to how we think about those words from the Declaration of Independence – “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and pursuit of Happiness.”  Do you consider quality, affordable health care as essential to securing our “unalienable Rights?”  If so, then that would imply that there should be a guarantee that every single American should have coverage.  Following that line of thought leads me to believe that the best way to ensure that every American has access to quality, affordable health care is through a single-payer Medicare for all type system.

               I know some will disagree with me and so I have two questions.  1) Do you believe that access to quality, affordable health care is essential to securing the Rights our Founding Fathers fought for? Why?  2) If yes, how do you propose to provide that health care for all Americans without using some form of universal health care?