Friday, August 10, 2007

Issues of the 2008 Presidential Election : National Health Insurance (Public Health Care Insurance)

The World Health Organization (WHO) in its much criticized 2000 report (.pdf of full report) on the health systems of the countries of the world ranked the United States in 37th place, one spot ahead of Slovenia and one spot behind Costa Rica. Research published in the British Medical Journal in 2003 turned out a new list, in which the USA fares somewhat better in 16th place, but America still lags behind almost all countries having national health insurance programs:

1. Sweden
2. Norway
3. Australia
4. Canada
5. France
6. Germany
7. Spain
8. Finland
9. Italy
10. Denmark
11. Netherlands
12. Greece
13. Japan
14. Austria
15. New Zealand
16. United States
17. Ireland
18. United Kingdom
19. Portugal

Due to American reliance on local solutions rather than on a more uniform federal system of health insurance, health care throughout the United States also varies greatly from state to state, as shown by the United Health Foundation in providing the 2006 America's Health Rankings.

National Health Insurance (Public Health Care Insurance) is not a New Issue


The debate about national health care and national health insurance has been around for a long time.

The NDT National Debate Tournament for collegians in 1960-1961 had as its topic: "That the United States should adopt a program of compulsory health insurance for all citizens."

The national high school debate topic in 1963-1964 was Medicare. I remember this well, having debated that topic for my high school in my senior year.

In 1977-78 the National High School Debate focused on "How Can the Health Care of United States Citizens Best Be Improved?"

National Health Care was the national debate topic for high schools in 1993-1994.

National Health Insurance is not an issue about collectivism, socialism or communism but about HEALTH CARE

The first thing that must be dispensed with is the antiquated argument that national health insurance is somehow collectivistic, socialistic or communistic.

I recently talked to someone from the US military who confided that the military, judged by the benefits it provides, was about the most "socialistic" organization around, if one wanted to use that term. The medical benefits that the US military provides through TRICARE are as follows:

"Health benefits are available for all seven branches of the Uniformed Services: the Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the Public Health Service, and the National Oceanic and Atmospheric Administration....

TRICARE provides benefits for Active Duty personnel, Retirees, Reservists & Guard members called to Active Duty, and certain family members....

Active Duty personnel are automatically enrolled in TRICARE Prime. Others may choose from several options.

Civilian inpatient and outpatient care is provided for the following three general categories of recipients:

1. Family members of Active Duty uniformed service members.
2. Family members of uniformed service retirees and family members of uniformed service members who died while on active duty or during retirement.
3. Certain individuals who were either voluntarily or involuntarily separated from a uniformed service member (for example, by divorce)."

As written at About.com:

"Depending upon their status, active duty members, retired members, members of the Guard/Reserves, family members, and certain veterans receive free or government subsidized medical and dental care. For the most part, this care falls under an overall program known as "Tricare." While the Tricare system may appear to be complicated at first glance, it's really not all that hard to understand."

Nobody seems to find great "socialistic" fault with this universal system of taking care of military personnel and their civilian families through a comprehensive government tax-payer funded medical care program, even though nothing would prohibit using a system of private medical care insurance. TRICARE is preferred, because it works better.

It is then foolish - and logically inconsistent - to argue that providing this same kind of national care to the rest of the US population is some kind of a contradiction of American principles. To put it mildly, anyone who argues that way is just talking corn-fed hogwash.

National Health Insurance is a Question of Form, Costs and Financing

The legitimate problems with providing any type of system of national health insurance or universal health care relate to form, costs and financing. The USA has many successful models to learn from.

Wikipedia has a nice article titled Universal Health Care which discusses those three aspects. The data provided show that health care in national health care systems in Europe, Canada, Australia and Japan is better than that in the USA - and it also costs less. Per capita expenditure for health in the USA is about twice that of countries with national health care plans - and yet, the countries with national health insurance have better health statistics then America does.

Those who argue that one can not compare Europe with the USA should then look to Canada, which instituted a universal health care plan some years ago and now beats the USA in every health category listed.

Canada also provides a model for meshing public and private systems, a solution definitely required in the USA as well.

As the Supreme Court of Quebec ruled in Chaoulli v. Quebec (Attorney General), [2005] 1 S.C.R. 791, 2005 SCC 35, private services must be allowed to compete with the public program, citing to the fact that many countries with national health insurance systems mesh those with private enterprise and capitalism (English version of the reasons delivered by DESCHAMPS J):

"In a number of European countries, there is no insurance paid for directly out of public funds. In Austria, services are funded through decentralized agencies that collect the necessary funds from salaries. People who want to obtain health care in the private sector in addition to the services covered by the mandatory social insurance are free to do so, but private insurance may cover no more than 80 percent of the cost billed by professionals practising in the public sector. The same type of plan exists in Germany and the Netherlands, but people who opt for private insurance are not required to pay for the public plan. Only nine percent of Germans opt for private insurance.

Australia’s public system is funded in a manner similar to the Quebec system. However, Australia’s system is different in that the private and public sectors coexist, and insurance covering private sector health care is not prohibited. The government attempts to balance access to the two sectors by allowing taxpayers to deduct 30 percent of the cost of private insurance. Insurance rates are regulated to prevent insurers from charging higher premiums for higher‑risk individuals (C. H. Tuohy, C. M. Flood and M. Stabile, How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations(2004), 29 J. Health Pol. 359). [Link added by LawPundit]

The United Kingdom does not restrict access to private insurance for health care (The Health of Canadians — The Federal Role, vol. 3, Health Care Systems in Other Countries, Interim Report (2002), at p. 38). Nor does the United Kingdom limit a physician’s ability to withdraw from the public plan. However, physicians working full‑time in public hospitals are limited in the amounts that they may bill in the private sector to supplement income earned in the public sector (p. 40). Only 11.5 percent of Britons had taken out private insurance in 1998 (Tuohy, Flood and Stabile, at p. 374), and only 8 percent of hospital beds in the United Kingdom are private (Quebec and France, Health Indicators: International Comparisons: 15 years of Evolution: Canada, France, Germany, Qu├ębec, United Kingdom, United States (1998), at p. 55). New Zealand has a plan similar to that of the United Kingdom with the difference that 40 percent of New Zealanders have private insurance (Tuohy, Flood and Stabile, at p. 363). [Link added by LawPundit]

Sweden does not prohibit private insurance, and the state does not refund the cost of health care paid for in the private sector. Private insurance accounts for only two percent of total health care expenditures and there are only nine private hospitals (The Health of Canadians — The Federal Role, at pp. 31‑33)."

Obviously, the USA will have to design a public health care insurance system suited to the particular needs of America, but there is no doubt that such a system is definitely needed and would be beneficial to the health care system in the United States.

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