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Deane Waldman

Deane Waldman

Posted: April 18, 2008 01:49 PM

"Universal Health Care" Is None Of The Above


Government supported health insurance will not achieve universal health.

A phrase recently touted in newspapers, on radio and TV is "Universal Health Care." Expert pundits and Presidential hopefuls wave it about like the Holy Grail: the ANSWER to all health care woes. "Universal Health Care" is none of the above: not universal, not healthy, and not caring.

"Universal...
There are millions of people who currently qualify for existing forms of government-subsidized medical insurance but refuse to sign up. Regardless of their reasons - immigration status concerns; complexity of the system; fear of the government; or making "too much money" - they still need medical services. Should they get care or not? When they do, who pays? How will "universal health care" solve this?

...Health...
"Universal Health Care" is code for everyone being covered by health insurance. This has nothing to do with our being healthy or having our health restored when sick. People with insurance still put unhealthy things in their bodies, refuse to exercise, and many who do, ride bicycles without helmets.

"Universal Health Care" is promoted as the Answer to all problems: rising costs; errors and adverse outcomes; shrinking access; and personnel shortages. Someone please show me how insurance-for-all will magically fix these.

...Care"
Do you really think that "Universal Health Care" will suddenly make people in healthcare more caring? Hogwash. They already care a great deal but have to work within a system that puts a low premium on caring, a system that actually discourages spending time with the patient. The behavior that is rewarded is efficiency: caring for the most number of patients and therefore spending the least time with any one patient.

If all the doctors and nurses finally said "enough" and quit; if hospitals had to close their doors due to giving away their services for free (mandated but unfunded care) then all the medical insurance in the world will not provide us health care.

The Cost
Experts all agree that the expense of health insurance for everyone will be huge. The only argument is the actual number: how many hundreds of billions of dollars - money we do not have.

Taiwan has a single-payer, government-run health fund, which everyone is required to join and which offers extensive benefits. There are no gatekeepers and everyone has a smart card with all their medical information. Great, except that the government has had to borrow from banks to cover its day-to-day costs. In Japan, with a system similar to Taiwan's, the financial crunch has landed on the providers rather than the government. Many hospitals and doctors are simply quitting because they cannot make payroll.

No amount of money will cure healthcare because lack of money is not the reason for its problems. Again, we are treating a sign of dysfunction, not a cause. The only healthcare funding schemes that will work in our capitalist society must allow supply to balance demand. Right now, there is no balance because the consumer (patient), payer (a third party) and cost-driver (doctor) are three different people all playing by different rules. Only when the consumer is the payer, will there be a reason to economize. Only when the cost-driver and consumer are seeking the same outcomes, will we start to receive value for our health care dollars.

What We Want and Need
Early in his career, actor Jim Carrey wrote himself a check for $15 million. He believed that if he could write it, someday the check would become real, and eventually, it did. If we clearly state what we want from healthcare, it can happen.

We want to be healthy and to have whatever health care is necessary to stay that way. We do not want to go broke paying for it or be taxed to death. No modification - universal health care; HIPAA; Patients' Bill of Rights; caps on malpractice awards; UMRA - can make the current system give us what we want. Therefore, we need a new system.


Our new, effective system will reward us for staying healthy. The healthier we are as a people, the more productive and successful we are as a nation. Our new system will simultaneously prevent errors and take risks. Without risk, there is no learning and without learning, we will never have better medical outcomes than we have right now. Our new system will recognize who is responsible for our health and for our health care: we are. Such a system will promote what we want - universal health.

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