In the past, I thought that healthcare was should be the responsibility of the individual without any interference from the state, although on reflection based on my own reading and personal experiences, I have changed my mind. It is clear to me now that all countries have a duty to their citizens to provide healthcare to those who cannot afford it, and that in poor countries like Haiti, the majority of people cannot really obtain healthcare and other basic necessities simply through their own efforts. I agree with Tracy Kidder that “clean water and health care and school and food and tin roofs and cement floors, all of these things should be considered a set of basics that people must have as a birthright” (Kidder 91). I also know of people who would have been in serious difficulties if they had been unable to afford health insurance. My grandmother had cancer, for example, and would never have been able to afford hospice care, radiation and chemotherapy treatments on her own, while even my brother who needed eyeglasses would have not been able to perform well academically if he had not been able to afford an eye exam. In addition, I believe that the industrialized nations have a moral duty to assist poorer countries, especially when their own pollution and industrial and nuclear waste are causing global warming as well as many health and environmental problems. Although the Industrial Revolution made human progress possible in this world, it also created many negative impacts in human health and the environment that must be addressed on the global level.
Universal healthcare should be available to everyone in the world, and the best system would be a Canadian-style, single-payer form of national health insurance. From the readings I am aware that a Communist country like Cuba has created a system of socialized medicine that is far superior to most of those in poor countries, although it has been done at a considerable cost in human freedom. I agree that there is “no question but that Cuba had pulled off something difficult and, in the view from Haiti, enviable first-rate public health care, equitably distributed in spite of severely limited resources”, and that even though the system is a dictatorship that has also been true of Haiti and many other poor countries that have no decent public healthcare systems (Kidder 208). Nevertheless, I would prefer to obtain the same goal of universal healthcare within a democratic system wherever possible. Even in a rich and supposedly democratic country like the U.S., healthcare has still not become a universal right available to all citizens, and in fact the system in the United States is the most unjust and unequal in the Western world and the most expensive as well. Even worse, the injustice of the present system is borne most heavily by the poor, working class, and members of minority groups who lack health care coverage at work and cannot afford private insurance. North of the border, Canada has a far better model for health care and one that most U.S. reformers have demanded since the 1940s. Medicare has been a very popular public service in Canada since it was first passed in 1966, and provides universal health care paid for out of general tax revenue. In the U.S., Medicare covers only those over age 65, but it should be modified into a Medicare for all system.
In Canada medical and hospital services are 100% publicly financed under Medicare and under the Canada Health Act, no private charges may be made for physician and hospital care provided through federal funds and in effect private health insurance has been completely removed from those areas (Tuohy 366). Drugs, dental care, nursing homes, long-term care are also publicly subsidized “to vary degrees and on different terms across provinces”, and although 72% of the population carried some form of private insurance for these services it accounts for only 10% of overall healthcare spending (Tuohy 367). This has increased from about 3% in 1971, but even so, in Canada the most important players in healthcare by far are the federal and provincial governments and medical and hospital associations, not private insurance.
Few people in Canada would ever want a U.S.-type of system, which is well known to be inequitable to low-income groups. Insurance industry lobbyists with ties to U.S. corporations always strive to create a seemingly contentious debate over healthcare in Canada, by persistently attempting to make inroads in the publicly-funded system. At present, it is still against the law in Canada to offer private health insurance for any type of medical care provided by the public system (Wilson 118). Canada’s single-payer system not only guarantees universal access to all regardless of income, its costs per capita are lower than those in the U.S., which has never had universal access in its history. Indeed, up to 100,000 people in the U.S. die every year because they have no private insurance and cannot afford access to healthcare, which is simply morally unacceptable in a modern, Western society. Certainly nothing like this would be tolerated in Canada, which would do well to keep its present system in place instead of experimenting with American-style privatization schemes.
A system of national health insurance and universal coverage is essential in the world today because modern healthcare is extremely expensive and unaffordable by most poor, working class and middle class persons unless the costs are covered by subsidies, insurance or government programs of some type. Nor does private health insurance provide broad and universal access to all parties on an equal basis. Costs for private insurance are actually highest for those with the lowest incomes and greatest health care needs, and indeed there is “a well-established inverse relationship between socioeconomic status and health status” (Hurley 236). Economists tend to value choice in health care and also advocate a system that provides for the greatest possible access, while ethicists state that access alone is not the most important factor but “access to or utilization of needed health care services” (Hurley 235). Low-income patients will be affected in an especially negative way, given their relative lack of education and access to information, and generally reduce their level of healthcare consumption below optimal levels in a private system (Hurley 237). Hurley finds that “parallel systems of private finance can drain resources from the public system, erode public support for the public system, lead to longer waiting times in the public sector, and make it harder to provide all members with timely access to high quality services” (Hurley 238). Putting a parallel private system in place is not a neutral add-on, but a danger to the viability of the public system and to the ethical goals of universal and equal access.
Canada’s single payer system of national health insurance is far preferable to the American system based on private insurance, and this is the type of reform that is necessary in the U.S. to provide universal coverage. Even from an economic point of view, the U.S. spends more per capita on health care than any other Western nation, but has never in its history achieved universal coverage. In Massachusetts and other states that have passed laws requiring the purchase of private health insurance, which is also the core of Obama Care, those in the lower income brackets are supposed to receive government subsidies. In reality, the private insurance companies have been raising premiums on the grounds that they now have to cover the uninsured and those with preexisting conditions, and the individual mandate has meant a considerable boost for their bottom lines. In the U.S., the insurance industry, with its considerable influence in Congress, was also able to block even the semblance of a public option or competing government insurance plan. For the U.S. and the rest of the world where healthcare coverage is inadequate, the main goal should be to create a Canadian-style system of national health insurance wherever possible.
WORKS CITED
Hurley, J. “Ethics, Economics, and Public Financing of Health Care” Journal of Medical Ethics 27 (2001): 234–239.
Kidder, Tracy. Mountains beyond Mountains: The Quest of Dr. Paul Farmer. NY: Random House, 2004.
Tuohy, C.H. et al. “How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations” Journal of Health Politics, Policy and Law, 29.3 (June 2004): 359-93.
