Current Issue
Spring 2014
BMM Current Issue
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A Matter of Principle
All health care systems should guarantee universal basic coverage.
In 1994, the conservative government in Taiwan decided to implement a health care system for its citizens. One of the “new Asian Tigers” enjoying economic growth and prosperity, Taiwan decided to make a major investment in health. Because the country felt indebted to the United States and admired our economy and culture, it looked to us first for a health care system model. And after careful consideration, they decided not to follow us. Why? Because our system does not provide care to all citizens. This principle, which is the starting point for almost all systems in the developed world, can be simply stated: All people should be provided health care regardless of their ability to pay.

In the U.S., we have not accepted this principle. My own beliefs on the issue are based on T.R. Reid’s seminal book, The Healing of America. To me, it is a matter of principle, of ethics, a moral question. Should those who don’t have the resources to pay be denied penicillin for a sore throat to prevent rheumatic fever? Should a child with asthma not receive appropriate care and medications? Should a woman not receive a Pap smear? Our system provides emergency care, not routine, chronic or preventable care for everyone. Most developed countries have decided that they have enough resources to ensure that everyone has access to at least basic medical care without concern for costs. We still debate the issue. We should decide, firmly and without equivocation, to guarantee health care to all our citizens.

Cost and accessibility have been major subjects of debate during our health care battles. In other countries, these problems were solved when universal coverage was the guiding principle. It is also true that each country solved them according to its individual culture and outlook. One solution is for providers to be private, but for the government to control prices directly. For example, France (by many measures ranked first in the world in terms of health), has private physicians, private hospitals, and private, not for profit insurance companies. Everyone is covered. Patients pay the provider but are compensated within five days. The government sets prices. Cost is one half what it is in this country, and quality measures are significantly better. Providers negotiate with the government instead of the insurance companies. While the French complain about their system, they are intensely proud of it and feel it is far superior to that of the U.S.

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