“Should the U.S. provide basic health care to all its citizens?” | Guest Opinion

The Columbia Basin Badger Club will hold a free virtual Zoom forum on this question Oct. 15 from noon to 1 p.m.

Even before COVID-19, health care was not an abstraction for 330 million U.S. citizens. From migraine headaches to open-heart surgery, we not only benefit from amazing medicines and life-changing procedures, we also face a bewildering array of insurance plans, in- and out-of-network providers, unexpectedly high bills, confusing paperwork.

This election year brings health care again to the forefront. COVID-19 has exposed public health challenges such as the need for free testing, the fragility of employer-based insurance, and lack of state and federal coordination.

How are we to determine the best way forward?

First, we must recognize that U.S. health care is four separate systems: 1. Employer-based insurance, started in WWII because of wage controls. 2. Medicare and Medicaid, based on Canada’s model. 3. Veterans Administration, based on Britain’s model. 4. Out-of-pocket uninsured.

Obamacare, now threatened by pending court action, moved toward basic health care for all by reducing the uninsured population from 47 million to 26 million — a number rebounding as people have lost jobs recently and the accompanying insurance. The uninsured often can’t afford out-of-pocket costs for a doctor visit, let alone prescribed medicines and treatments.

Should basic health care depend on income, even if need arises simply from bad luck? So far the answer in the U.S. has been yes. The well-off receive the world’s best care; the uninsured little or none. What prompts us to ignore the suffering and early death of millions of citizens? No other developed country does this.

Yet, if we ultimately agree basic care is a laudable goal, the stubborn question remains how. We might look to Europe (Germany, France, Switzerland for instance) or the Far East (Japan, Taiwan), where we find plans offering basic care with a blend of governmental and free-market components. They’re not purely socialist like Britain’s National Health Service.

These countries pay for universal health care through taxes or individual mandates. Their governments negotiate, limit, and post drug prices and procedure fees, while offering a wide choice of providers. They incentivize preventive care and eliminate the question of pre-existing conditions.

The results are significant, about a 40% lower cost as a percentage of their GDP than in the U.S. Key studies, such as by the Commonwealth Fund, find these plans also lead to better overall health outcomes and practically zero bankruptcies.

Americans prize freedom of choice and hold a strong aversion to taxes. But are we, collectively, wasting more than $1 trillion a year for that privilege? And aren’t we already limited to in-network providers? Should we consider health care an essential service and fund it like public schools or city fire departments?

Finally, why does U.S. health care come with a $3.6 trillion price tag? Some say crucial research and innovation drive up prices. Others argue administrative costs for employer-based coverage, now 17 percent, could be reduced to the 2 percent for Medicare.

Still others blame excessive profits – a 2017 federal GAO report noted that over a recent 10-year period drug company profits ranged between 15 and 20 percent versus non-drug company profits of 4 to 9 percent. Do entrenched interests hold outsized influence on Congress?

To examine these complex questions, the Badger Club will present three speakers. Martha Parry Clark, board member and secretary of the American Diabetes Association, will focus on the predicaments patients face with the cost of insulin. Bill Kabasenche, associate director of WSU’s School of Politics, Philosophy and Public Affairs, will discuss the ethical considerations of equal access. Roger Stark, retired cardiac surgeon and health care policy analyst at the Washington Policy Center, will argue the free market remains the best model for the U.S.

It should be a lively discussion.

Register on the club’s website columbiabasinbadgers.com.

This story was originally published October 14, 2020 at 1:50 PM with the headline "“Should the U.S. provide basic health care to all its citizens?” | Guest Opinion."