We’re not “there” yet, are we?
National health care-wise, that is. The Affordable Care Act – signed into law this year after such a massive battle – was an important first step, especially after more than 100 years of trying. But despite bringing much-needed help to millions of Americans, the bill fell short of the progressive goal of universal coverage, uniform benefits and effective cost controls through non-profit financing, fundamentals of all national health care systems around the world.
Just as Social Security and Medicare evolved and were improved, so will our new health care system. It’s a first step, but a first step to where? And when we finally get “there,” what is “there” going to look like?
The first thing to remember is that none of the national health care systems around the world look exactly alike. In fact, Canada doesn’t even look like it’s supposed to and they’ve been “there” since 1964.
Over here, Canada’s single-payer health care system is sometimes portrayed as perfect. It covers everybody, includes all services, doesn’t cost Canadians a single penny in co-pays or deductibles, and there are no mean, nasty private insurance companies mucking things up.
A closer look, though, reveals that, technically speaking, Canada is not single-payer at all. With 13 Canadian provinces and territories operating their own health authorities and sharing costs and rules-setting with the federal government, Canada is a 13-payer system. That’s why some provinces require co-pays and others don’t.
Some of them also don’t cover certain prescriptions, dental and vision services, ambulance travel or private hospital rooms. That’s why there are still private insurance companies around selling supplemental coverage to two-thirds of all Canadians.
While Medicare is Canada’s most popular social program and a source of national pride, Canadians freely admit that “timely access to services,” or wait times, is a problem.
Not what most of us imagined a single-payer system would look like, eh?
All this is not intended to disparage a health care system that provides excellent care to all its citizens – and outsiders – for $3,000 per person less than the U.S. and is overwhelmingly supported by citizens regardless of political party.
It is intended, however, to warn against any and all forms of idealistic or dogmatic thinking within our own health care movement.
So let’s agree. Not every health care system looks exactly alike. No national health care system is perfect. And ours won’t be, either.
American journalist T.R. Reid, author of “The Art of Healing,” explains that national health care looks different around the world because each country has its own unique political, economic, social and cultural traditions. Thus, the health care system is decentralized in Canada because it has a history of decentralized government.
The lesson for American activists is for us to really get to know our nation’s own political, economic, social and cultural traditions so well that we can lead an evolution from the Affordable Care Act (ACA) to a national health care system that Americans can identify with and proudly claim as their own.
We have much to learn from other countries and their health care systems, but we also have much to learn from American history and our own people.
We can begin that learning process by explaining what benefits ACA has to offer. First, it gets us out there talking to people and engaging them in greater numbers than we did during the struggle leading up to passage of the ACA. We also have to undo some of the damage Tea Partiers have done to any kind of health care reform.
Second, this “implement and improve” process can help us find out what Americans are thinking: what they like about reform, what they don’t like about it and what they would like to see changed. And we won’t learn anything from people if all we do is lecture at them.
The third thing we need to do in the process of getting “there” is to frame the health care issue in a way that wasn’t done very well or consistently during the campaign: health care as a moral issue.
Reid writes, “The design of any nation’s health care system involves political, economic and medical decisions. But the primary issue for any health care system is a moral one. If we want to fix American health care, we first have to ask a basic question: Should we guarantee medical treatment to everyone who needs it?”
Or put more bluntly: “Should a homeless person receive the same level of health care as a bank president?”
Once we, as a nation, can answer that question with a resounding “yes,” does it really matter whether our American health care system looks like Canada’s, France’s or something totally different?
Whoa, wait a minute there. What’s France got to do with it?
Ranked as having the number one health care system in the world by the World Health Organization, France is one of many nations that look like single-payer but, in fact, have multi-payer health care systems. In France, Germany, Denmark, The Netherlands, Japan, Switzerland and Israel, private insurance companies collect premiums and pay all health care bills under strict government regulation for NO profit. These health care systems come out of their nations’ traditions, with sickness funds and employer-based private insurance having preceded the transition to national health care.
So how do we finally get “there?”
To speculate, we might evolve toward a multi-payer system because we have a tradition of employer-based health care. Many of the structures for that kind of national health care system have already been put in place by the ACA.
We could possibly evolve toward a single-payer system since we also have a single-payer tradition with our Medicare program. We could build on state experiments with single-payer like Vermont’s, or we could lower of the age for eligibility for Medicare to 55, as was proposed in congressional debate this year. We could also open up Medicare to all Americans by allowing them to buy into it at any age, as the conservative editor of a conservative local newspaper recently suggested.
And when we get “there,” we might turn out to be a 50-payer system with each state operating its own health care authority. Who knows?
There are lots of good ways of getting “there,” so let’s keep open all possibilities. And, above all, let’s listen to the directions Americans are giving us.