Subject: [SciPol 409] On Universal Health Care

From: "Dan Agin" <[email-masked]>
Date: Thu, 29 Mar 2007 11:37:41 -0500

On Universal Health Care

Human health care is applied science -- and an applied science
with an important  interface with politics. 

COUNTRIES WITH UNIVERSAL HEALTH CARE:

Argentina, Australia, Austria, Belgium, Brazil, Canada, Cuba,
Denmark, Finland, France, Germany, Greece, Ireland, Israel,
Italy, Japan, The Netherlands, New Zealand, Norway, Poland,
Portugal, Russia, Saudi Arabia, Seychelles, South Korea, Spain,
Sri Lanka, Sweden, The Republic of China (Taiwan), and the United
Kingdom are among many countries that have various types of
universal health care systems.

Mexico, South Africa, and Thailand are among those nations
attempting to implement universal health care systems.

Universal health care is a state in which all residents of a
geographic or political entity have access to health care.

Universal health care is not tied to any particular health care
system, though it is the motivation for the socialized medicine
practiced in countries such as Italy, the United Kingdom and
services provided by the private sector. Some theorists claim
universal health care could be accomplished via private
enterprise, without government regulation of the health care
industry, but no completely private system currently exists.

Universal health care is a broad concept and has been implemented
in several ways. The common denominator for them all is that
every resident of a geographic area - such as a country - is
mandated to have health insurance. In market-based systems,
a.k.a., "capitalistic" systems, as used in part by the USA, the
mandate is coupled with a private insurance market. In government
monopoly systems, a.k.a., "socialistic" systems, the mandate is
coupled with a government agency that pays for a wide range of
health benefits. The government monopoly is paid for with taxes,
most commonly on payroll, a year end tax income tax calculation,
or from general government revenues.

The variety of ways that a country can fund health care can be
highlighted by the example of Canada. Prior to the Universal
health care system, individuals paid out of pocket. Later the
Canadian government imposed monthly or yearly insurance type fees
per family or individual. Recently the government eliminated the
fee structure in favor of a strictly tax based funding system.
Today Canada has re-introduced and implemented added health
insurance tax through annual income tax system form.

There are no universal health care systems that cover all
thinkable health services. The Health Care System in Canada is a
case in point. It is socialized in the relevant aspect of
funding. This makes the Canadian system a single payer system.
Most health services are provided by private enterprises which
act as contractors, billing the government for patient care.

Single-payer health care is a system whereby one party, usually
the government, pays for the health care of everyone. In practice
this means that the government collects taxes from the public,
businesses, etc., creates an entity to administer the supply of
health care and then pays health care professionals. While this
replaces competing health insurance companies, some claim that it
tends to create a large government bureaucracy.

Universal health care can be implemented without having the
government pay for it in full, as in single-payer health care.
Hybrid health care models emerged from efforts to reconcile the
drive for expanded access and the drive against rising health
care prices. This model is geared towards getting past the
dichotomies that have stymied universal health care efforts, such
as whether the state or federal governments should take the lead,
whether the primary jurisdiction for negotiating health care
should be at the market or government level and whether health
care is more of an individual or societal responsibility. There
are no examples of single payer systems that have successfully
converted into a hybrid model, although there are examples of
countries that have moved from private insurance to a hybrid
model, one example is Germany.

No such system currently exists, although the reform bill in
Massachusetts has characteristics of a private universal model.
Advocates of the free market define a private universal health
care system as one in which health care would be affordable to
all, and anyone who wanted to buy health care could do so in the
free market. Some of these free-market health care systems would
provide vouchers to those who couldn't afford to pay. Others
would not involve any wealth redistribution.

If a government subsidizes health care, the free market will
never be able to develop a private universal health care system,
advocates argue, claiming this is why no such system has ever
existed.

Bill Frist argued in the New England Journal of Medicine that the
free market will keep costs down, because individuals who have to
pay for their own health care will make wiser decisions and not
spend money on unneeded or inefficient care. A deregulated free
market, Frist argues, will also encourage efficiency and
innovation.

COMMON ARGUMENTS WAGED FROM SUPPORTERS OF UNIVERSAL HEALTH CARE
SYSTEMS ARE:

    * Health care is a right or entitlement.
    * Ensuring the health of all citizens benefits a nation
economically.
    * Provides coverage to all citizens regardless of ability to
pay.
    * Health care is increasingly unaffordable for businesses and
individuals.
    * Universal health care would provide for uninsured adults
who may forego treatment needed for chronic health conditions.
    * Providing access to medical treatment to those who cannot
afford it themselves reduces the severity of epidemics by
reducing the number of disease carriers.
    * Reduces wastefulness and inefficiencies in the delivery of
health care.
    * Aligns incentives for investment in long term health-care
productivity, preventive care, and better management of chronic
conditions.
    * Encourages patients to seek preventive care enabling
problems to be detected and treated earlier.
    * A centralized national database makes diagnosis and
treatment easier for doctors.
    * Medical professionals can concentrate on treating patients
rather than on administrative duties.
    * Profit-driven care leads to more deaths<38> and is more
expensive.
    * Universal health care can act as a subsidy to business, at
no cost to the business. The Big Three of U.S. car manufacturers
cite health-care provision as a reason for their ongoing
financial travails. The cost of health insurance to U.S. car
manufacturers adds between USD 900 and USD 1,400 to each car made
in the U.S.A.
    * The profit motive adversely affects the cost and quality of
health care.

COMMON ARGUMENTS WAGED FROM OPPONENTS OF UNIVERSAL HEALTH CARE
SYSTEMS ARE:

    * Health care is not a right.
    * Providing health care is not the responsibility of
government.
    * Increased waiting times, which can result in unnecessary
deaths.
    * Poorer quality of care.
    * Unequal access and health disparities still exist in
universal health care systems.
    * Government agencies are less efficient due to
bureaucracy.<35><42> Administrative duties, by doctors, are the
result of medical centralization and over-regulation, and are not
natural to the profession. In fact, before heavy regulation of
the health care and insurance industries, doctor visits to the
elderly, and free care, or low cost care to impoverished patients
was common; governments regulated this form of charity out of
existence.<47> Universal health care plans will add more
inefficiency to the medical system because of more bureaucratic
oversight and more paperwork, which will lead to less doctor
patient visits.
    * Profit motives, competition, and individual ingenuity lead
to greater cost control and effectiveness.
    * Uninsured citizens can sometimes still receive emergency
care from alternative sources such as nonprofits and government-
run hospitals.
    * Government-mandated procedures reduce doctor flexibility.
    * Healthy people who take care of themselves have to pay for
the burden of those who smoke, are obese, etc.
    * Loss of private practice options and possible reduced pay
dissuades many would-be doctors from pursuing the profession.
    * Causes loss of insurance industry jobs and other business
closures in the private sector.
    * Eliminates a right to privacy between doctors and patients
as governments demand power to oversee health of citizens.
    * Empirical evidence on single payer insurance programs
demonstrates that the cost exceeds the expectations of advocates.
    * Governments, such as Canada, have outlawed medical care if
the service is paid for by private individual funds. This results
as governments attempt to control costs by gaining or enforcing
monopsony power.

Adapted from Wikipedia. For more information:
http://en.wikipedia.org/wiki/Universal_health_care

Yours in discourse,
Dan Agin

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From: John Wagner <[email-masked]>
Date: Thu, 29 Mar 2007 14:21:29 -0700

> On Universal Health Care
Here are a few facts to contemplate;

*From the National Coalition on Health Care*:
In 2004 (the latest year data are available), total national health 
expenditures rose 7.9 percent -- over three times the rate of inflation 
(1). Total spending was $1.9 TRILLION in 2004, or $6,280 per person (1). 
Total health care spending represented 16 percent of the gross domestic 
product (GDP).

U.S. health care spending is expected to increase at similar levels for 
the next decade reaching $4 TRILLION in 2015, or 20 percent of GDP (2).

In 2006, employer health insurance premiums increased by 7.7 percent - 
two times the rate of inflation. The annual premium for an employer 
health plan covering a family of four averaged nearly $11,500. The 
annual premium for single coverage averaged over $4,200 (3).

Experts agree that our health care system is riddled with 
inefficiencies, excessive administrative expenses, inflated prices, poor 
management, and inappropriate care, waste and fraud. These problems 
significantly increase the cost of medical care and health insurance for 
employers and workers and affect the security of families.

  Tommy Thompson: America's Health Care System Will Collapse by 2013

*Thompson* -- four-term governor of Wisconsin and /former federal 
secretary of Health and Human Services/.

Even though American health care is the best in the world, said 
Thompson, he predicts the health care system will collapse about 2013. 
"The first reason is that we spend about 16 percent of our GDP on health 
care, while other countries spend from four to 11 percent. Japan spends 
7 percent. We spend a lot more than any other country." And, he said, by 
2013 we'll double the expenditures; from $2 trillion to $4 trillion -- 
from 16 percent of GDP to 20 percent of GDP.

The second problem with health care, he said, is that companies of 50 or 
fewer employees are getting out of the health care business, which 
shifts the burden to state and other private-pay employees. Thompson 
went into some detail as to where health care funds go, and what can be 
done about it. Seventy-five percent of the $2 trillion goes for chronic 
illnesses, and 125 million people have one or more chronic illnesses, 
some of which are preventable.