No Easy Answers for Universal Health Care Coverage
By Christopher Ryan
Health insurance — protection against the medical costs of illness or injury — has only been around since the rise of modern medicine, about 100 years. Before then, people got well by themselves or they didn’t. There weren’t any emergency rooms, intensive care units, x-rays, magnetic resonance imaging (MRI) or even the blood tests that are standard today.
So, when it comes to health insurance and big decisions about how to protect everybody with universal health-care coverage, no country in the world has had much time to figure out the answers. What’s more, the answers aren’t the same from country to country. In the United States, unique attitudes toward health care might be the biggest roadblock to a successful universal health care system of any kind.
Universal health care might take many forms, but every developed country in the world — except the U.S. — has it. Why is this country holding out?
The story begins in World War I. Before the war, the U.S. was on the brink of adopting universal health care based on the German system. When Germany became an enemy, the idea of adopting anything from that country was considered unpatriotic.
Then World War II rolled around. To help fund the war effort, the government ordered wages frozen. To keep workers on the job, employers had to find another way to compensate, and hit on the idea of offering health-care coverage as a benefit.
In the business boom that followed the war, employers had to work even harder to keep employees, so health insurance benefits became almost a standard part of workers’ compensation. Employer-funded health insurance became the accepted system in this country.
It wasn’t until 1993, during the first Clinton Administration, that universal health care once more became a topic of discussion — and it was crushed. Now, 15 years later, it’s back on the table. But why?
In this country, according to the National Coalition on Health Care, 47 million Americans didn’t have health insurance in 2005. American citizens made up 80 percent of the uninsured and, in 2006, 20.2 percent of the uninsured were working adults.
These statistics go a long way toward explaining the renewed interest in universal health care as more people are feeling the pinch.
And there’s more: In 1987, 70 percent of workers and their dependents received employment-based health insurance. By 2006, only 59 percent were covered by their employer. The rest are left to find their own — often very expensive — insurance or go without.
So much for the system born during World War II; employers aren’t shouldering the burden anymore.
Myles Gartland, associate professor of economics at Rockhurst University in Kansas City, Missouri, adds yet another twist. Many people with health insurance can’t afford to use it, he says. The co-pays and deductibles are too high.
Hilda Fuentes, CEO of Samuel U. Rodgers Health Center in Kansas City, Missouri, sees the uninsured and underinsured every day as they come to her facility, using the emergency room for primary care. With cutbacks in Medicaid, which provides government-funded health coverage for the poor, more people are being forced to seek help at safety-net institutions like Samuel U. Rodgers.
“They would be better served at a doctor’s office or community health center,” Fuentes says of her patients, who often arrive with ailments that could be prevented with regular medical care. “We are at capacity. This is a great financial strain on providers.”
Clearly, the current health-care coverage system is approaching the breaking point, and for many people, it reached that stage a while ago. The only question is where to go from here.
Universal health-care systems in the United Kingdom and Canada, as well as other countries, are often held up as models for the U.S. However, as much as Americans need help with their coverage, Gartland advises against rushing to adopt another system wholesale.
The U.S. has headed down a different path than other countries when it comes to health coverage, Gartland says. It will be very difficult to break away from the employer-supported approach and move into a government-sponsored system. The new systems won’t be like Canada’s or the U.K’s, where the government handles everything. More likely, it will be a mixture of private and government funding with mandatory participation.
American policymakers are also looking to France for a possible solution. In that country, employees, employers and the government share responsibility for funding universal health care. Most doctors work in private groups, not for the government, and many hospitals are privately owned. The World Health Organization ranks France’s system No. 1 for providing the best overall health care.
Many, if not most, Americans equate universal health care with the Canadian or British system, a completely government-run, single-payer approach that carries the stigma of “socialized medicine” with all its inefficiencies, delays and lack of compassion. Obviously, there are alternatives, but they might not succeed just because of the way Americans look at health care.
As Gartland explains, not only has the U.S. accidentally found itself on the employer-funded health-care path, with all its problems, but Americans have gone down a path of too-great expectations.
“The American public has come to expect the latest and greatest medicines and tests,” Gartland says. “We want access to top specialists at whatever time we want to go with little or no cost for the products and services.”
These expectations contribute greatly to the high cost of health care, and universal health care can’t fix the problem of skyrocketing costs. Simply put, no system can keep up with the rising costs of health care in the U.S. Until a solution is found to this pressing issue, mandatory coverage, spreading the funding responsibilities, or any other “solution” is unlikely to work.
For more information on universal health care you may contact
- The National Coalition on Health Care, 1200 G Street, NW, Suite 750, Washington, DC 20005 or call 202-638-7151
- Missouri Department of Health & Senior Services, P.O. Box 570, Jefferson City, Missouri 65102; phone 573-751-6400.
- Kansas Department of Health and Environment, 1000 SW Jackson, Topeka, KS 66612; phone 785-296-1500.
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