Getting to national health care

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.



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  • I think this is a great article. It offers pragmatic politics with a fundamentally radical goal – without pounding on the podium with a shoe!

    Posted by Smarter-than-a-teabagger, 06/05/2010 10:32am (5 years ago)

  • I liked the fact that in some countries, even though there are private insurance plans, they operate at NO profit.

    Get the profit motive out of health care. No good comes from a company offering health care, but is concerned about making a profit for its shareholders. The health care takes a back seat every time.

    Posted by Ronald Humphrey, 06/05/2010 6:06am (5 years ago)

  • It is without a doubt that we need and deserve a single payer healthcare system. H.R. 676 is such a piece of legislation. Unfortunatley the so-called liberals in the Democratic Party would not even give single payer the needed discussion, opting for continued corporate controlled healthcare.

    The reality of our situation is that so long as politicians are allowed to accept corporate bribes, we will not see meaningful change in either healthcare, immigration or labor law. Both major parties have no qualms in accepting "campaign donations" thus we the people are left outside without any real concern for our situation.

    To make matters worse the Supreme Court ruled earlier this year that corporate campaign restrictions were "unconstitutional" as corporations are now considered to be persons!

    With such obstacles we will have to triple our efforts for real healthcare reform! We must also give serious consideration to building a viable third party alternative to the corruption we have now. This party must be committed to peace, equality, labor rights, clean environment, gay rights and be willing to NOT accept corporate funding! This is NOT impossible, the first step begins within each and every one of us! Are YOU ready?

    Posted by Pancho Valdez, 06/04/2010 4:16pm (5 years ago)

  • This article is very good,emphasizing flexibility and democracy in health care evolution from progressive tradititons.
    Brother Sam Stark might agree that the organization and technology of medicine,though shared by nations,and unified by organizations like the mentioned W H O,may take a creative twist,fueled by geniuses like Dr. Drew ,Dr. Carver,Dr. Just,and Dr. Julian and the CPUSA's geniuses like Dr. Robert Hodes.
    Moreover,there have been contemporary health care workers, policy experts,scientists and activists who have been architechs of the movement which produced the positive change in health care delivery from the monopolists with the advent of ACA.
    Who knows what will evolve from Drew's blood bank system,maybe a stem cell and dna medical bank system for all people's improved health,in a new and phenomenal form?

    Posted by E.E.W.Clay, 06/03/2010 11:59am (5 years ago)

  • No question that we need to listen to the people, but we must also lead with creative ideas and a program. We should settle for no less than single payer. Let the administration and the Congress be the pragmatists and suffer the consequences.

    Let's not reinvent the wheel. Single payer as well outlined by the most progressive health care advocates still has wide popular support and is an important prerequisite to socialized medicine. The people did speak very clearly during the debate. Not even putting single payer on the table was an affront to democracy and a majority position of both the consumer and the health care providers.

    Of course we need to have a United States version of single payer, but is it necessary to add ammunition to the nay sayers?

    Posted by David Bell, 06/02/2010 7:40pm (5 years ago)

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