"Universal health care" doesn't mean to you what it means to them. To Presidential hopefuls and self-styled expert pundits, it means universal health coverage or insurance. To the Public, it means unlimited health care for all without regard to financial means. These are very, very different. The first is an adjustment in current financing and the second requires a total overhaul - scrapping and starting over - of the US healthcare system.
Universal Health Insurance
Money can reduce barriers to access and can stabilize precarious finances of hospitals and providers. Money cannot give us good health. Good health requires healthy behaviors by us, and an unflinching recognition that we are responsible for our health, not the doctor, nurse, hospital or insurance carrier.
According to the National Institute for Health Care Management, "uninsured" does not equal "cannot afford health insurance." At least 25% of those currently without health insurance qualify for available medical aid programs but choose not to sign up. Whatever their reasons - immigration status; fear of big brother; can't be bothered; or a simple belief in total entitlement - they are uninsured by choice. Nonetheless, they still need (and will demand) health care, for free. As Robert Heinlein wrote, "Tanstaffl, there is no such thing as a free lunch!" Someone has to pay for their health care, and for yours and for mine.
Universal Health Care
What do we all want from so-called universal health care? We desire: easy access; to high quality, error-free, compassionate health care; without regard to our bank account; without bankrupting the country; and without stealing money needed for other social programs, infrastructure, and defense. "No Patient Left Behind" is a far cry from medical insurance for all.
Why Not Steal [A System] From Others?
Great Britain, Canada, Germany, France, Japan and Taiwan have universal health plans, all different. Each one spends much less of their GDP on health care than the US; most have better quality metrics; and each has been touted as a system we should adopt. How they really work, indeed whether they really work, is at present unknown, despite TR Reid's illuminating piece on Frontline. Each country Plan has problems.
The National Health Service (NHS) in Great Britain is trying to inject patient responsibility into a culture where the provider is considered responsible but not the patient. The NHS previously toyed with Patient Contracts and is now offering support for people to go to health clubs - to exercise and thereby reduce obesity. The Taiwan Government Health Fund has had to borrow from the banks to stay solvent. The NHS too has money problems and has contracted with Greece to do heart surgery on British citizens. Enrollees in the Canadian NHS routinely cross our border to get the latest (instead of outdated) technologies and to avoid long waits. Compare how many innovative medical improvements - drugs, new technologies, and innovative service approaches - come out of any of these countries compared to the US.
Despite the obvious and not-so-obvious deficiencies of these Plans, we can and we should learn a great deal from careful rigorous study of others' experience.
A Plan for the USA
More fundamentally, no system imposed on us - from the outside or even homegrown - will work. We are not Japan or Germany or even Great Britain. We have unique problems and unique strengths. They have their unique attributes. We must create our own answer for ourselves, in dialogue with...ourselves.
If we want No Patient Left Behind, we must "make it so" [quoting Captain Picard for you non-science fiction fans]. Watch for a subsequent Post titled "Universal Health Care Saves Money By..." which explains what we will pay for any universal health care plan. The costs will be much greater than dollars: we will have to change how we think.