In an empty classroom of Oxford's Magdalen College, our ad-hoc "health care discussion group" trickled into its first meeting: three Canadians, two Americans, an Indian, a Pakistani, an Australian, a South African, and a Zimbabwean. In preparation, we had read a perspective piece in the New England Journal of Medicine about the US debate regarding healthcare legislation. A spirited Pakistani physician, pursuing a doctorate in Clinical Medicine, launched the discussion. He looked squarely at both of the Americans in the room, a strappy economist from Virginia and me. Almost rhetorically, he asked, "why doesn't someone just provide care to these people without health insurance?" The look on his face offered further commentary, "come on, you're the richest, most technologically advanced, and most powerful country in the world, and you can't get care to 1/6 of your population?"
Since that day three months ago, I've thought often about the ironies of that question: my colleague comes from a country where a growing proportion of America's $650+ billion military budget is consumed. We've hemorrhaged billions of dollars and the lives of countless heroic servicemen boldly pursuing American security abroad. But when the security of over 40 million Americans living without health insurance within our very borders comes to question, hesitation.
Until about a day ago, I thought American lawmakers had successfully answered my young Pakistani friend's question. After all, recent history marked the first time both houses of the American legislature had passed anything that looked or smelled like health reform (although these bills, admittedly, only had the faint aroma of reform.) Alas, in classic congressional form, this answer was only a stall.
This time, I'd like to refer my friend's question to just one (albeit newly-anointed) American lawmaker: the Senator-elect from Massachusetts, Scott Brown.
So what do you think, senator-elect Brown? His question, is after all, fundamental to our newly-ignited healthcare debate: can a rich, developed country like the US provide health coverage to most, if not all, of its citizens? The answer is obvious in the rest of the developed world. For example, the consistently excellent public health outcomes in the United Kingdom are a product of its centrally administered National Health Service. UK health outcomes are substantially better than ours, despite spending considerably less per capita on health.
You probably don't know this, but an important driver of this health achievement gap is the poor health of the American uninsured. The evidence regarding poor health among the uninsured is astounding: the uninsured are less likely to undergo important health screenings, have poorer self-reported general health and physical functioning, are more likely to have strokes and heart attacks, are more likely to be diagnosed with late stage cancers, have worse outcomes following cancer diagnoses, and are likely to die at younger ages. Moreover, the uninsured are often forced to seek care in emergency rooms, where it is federally mandated that all patients be treated. Emergency room care is substantially more expensive than outpatient care; because they are unable to pay, the costs of emergency care for the uninsured are pushed on to those who can pay, contributing to our relative inefficiency as well as the rising cost of healthcare in the US.
In the midst of a floundering economy, with unemployment rates well over 20% in some parts of the country, as more Americans lose access to care, the importance and clarity of this young Pakistani man's question resound, wouldn't you agree?
I know you probably think that your election to federal office was a referendum on health reform, that you carry a mandate to overturn the progress that has been made before you. But might I remind you that you climb to the seat of service held by one of our country's greatest leaders and statesman, a visionary who called healthcare reform the cause of his life. Before you sit in that seat, perhaps you might do well to honestly consider my young Pakistani colleague's question. Because, although, in our wandering war effort, we've carried out drone attacks, and dropped bombs that have killed innocent men, women, and children in his country, his question concerns the safety and security of over 40 million innocent men, women, and children in ours.