The argument for universal health care

By Joe Livingston, MD, MPH
Special to the Saipan Tribune

I read with interest Mr. Bateman’s [I]Sour Grapes[/I] of March 26, 2008, where he attacked the idea of universal health care. He stated that the real losers in a socialized medicine system would be the consumers, and that doctors would leave a socialized system for greener pastures. He is wrong.

I’m a doctor, and I left the CNMI for greener pastures. I left to become a neonatologist, to take care of sick newborns and premature babies. The thing that I like the very most about my new profession is that we don’t do a wallet biopsy on a premee or sick baby that comes into the nursery. I don’t have to open an office in an affluent part of town and waste much of my time taking care of the worried well. I don’t have to watch anymore as the number of patients who come to see me drops because the rates for self-pay patients at CHC have gone up, and the poor simply cannot afford to pay. I can just practice medicine.

But what about the economic and business arguments? While it is possible to consider medicine like a product, much like the Spam you can buy at Joeten, it doesn’t make sense to treat it like other commercial items available in a free market. For one thing, the health care market hasn’t been a free market for years. Most people who get insurance get it through their employer, with limited or no choice. The insurance companies are businesses, not charities, so if you happen to have a chronic illness like diabetes before you get insurance, it is a pre-existing condition and it isn’t covered.

The argument for the free market is that the economic forces of supply and demand will create goods at the lowest natural price for consumers. If there are several people trying to sell you Spam, the laws of economics state that the prices will drop naturally to the lowest point for which it is still possible for sellers of Spam to make a bit of a profit. The way health insurance companies make money is by telling you that you don’t need Spam, that you can’t get Spam, or that you have to pay for Spam on your own because of your pre-existing condition. So much money in health care is spent to employ people in cubicles to look for reasons to deny insurance claims. It has gotten so bad that most private physician offices in the United States employee small armies of people to fight back against the insurance companies and continually resubmit claims that were initially denied. Instead of the law of supply and demand making things more efficient, the laws that govern competition among insurance companies make things worse. Whenever you spend $1.00 on health care, you spend 33 cents on administration. (See http://www.pnhp.org/news/2003/august/administrative_costs.php for more details.) That’s to pay people to tell you you can’t see a certain doctor, or you can’t have a certain test, or that such-and-such isn’t covered for you because you are on plan #19 instead of plan #18 of the same insurance company. It is crazy!

We already have socialized medicine, and it works really well—if you are over 65. It’s called Medicare, and, oddly enough, it is popular and efficient. Although the population of people over 65 is smaller than the rest of us, it is a sicker population, and so Medicare does a huge amount of business in the United States. Socialized medicine is simply the idea of taking Medicare and getting rid of the age requirement. Instead of paying huge insurance costs out of pocket, we would instead pay an equivalent amount of taxes. There would be far less waste because there would be far less costly fighting between private providers and insurance companies. It just makes sense to move this market out of the private sector where it doesn’t work, and back into the public sector where it can. Roughly half of the health care dollars are already spent in the public sector.

Now, I have to admit the public sector on Saipan does not normally inspire confidence, but the United States program called Medicare is much better run than, say, CUC. If the United States had some form of Universal Health Care, it might be a huge boon for the CNMI. Saipan could argue that, as part of the United States, folks on Saipan should get universal coverage too. Who knows, federal funding for universal health care through a universal Medicare type program in the CNMI might mean that CHC would get a larger, more stable medical staff and better resources to take care of the health problems of folks in the CNMI.

One of the biggest problems for me as a pediatrician is that I know that there is a relationship between how much money a family makes and how healthy they and their children are. Rich families who live in nice houses and eat good food and get plenty of entertainment and leisure have fewer health problems and live longer and have better lives. As a doctor, I like helping people who are sick, and that means helping people who are poor. Poor people, with worse housing, worse food, and more stress, are sicker and don’t live as long. Poor people need health care more often than rich people, but they don’t access it as often even when they need it. When they do access it, they can’t pay for it, so we all end up paying for it out of our own pockets through taxes anyway because we don’t like to watch poor people die on the streets. Nonetheless, it is a sad thing whenever I hear somebody talk about how great our health care system is in the United States, because it is great if you happen to be Bill Gates but not for the working poor and many in the middle class.

Universal health care makes economic sense, it would help the CNMI, it would make the delivery of health care more efficient, and it would put the bulk of health care resources back where they belong: in actually delivering health care. Would it be perfect? No. But it’s far better than telling poor families with sick kids to beat it because they don’t have any cash, and then having us all pay for it when the kid ends up in shock in the emergency room and possibly dead or permanently disabled. Other countries with higher life expectancies (like Canada) pay far less on their health care system and cover everybody. Why cant we?