As we continue to get wrapped around the axle of intricate detail in the Affordable Care Act (ACA) now before SCOTUS, we are experiencing a classic case of not seeing the forest for the trees. While we debate the minutia of a several thousand page document, and critics such as Michele Bachman claim it will “infringe on personal liberty”, what we really ought to be discussing is assuring that all our citizens will have affordable and universal health care – just as every developed nation in the world, except one, now provides its citizens! The one developed nation without universal health care: the United States of America. And the arguments against the insurance mandate are so spurious and weak (when viewed globally), it is surprising they are even challenged. Indeed, that is precisely how the rest of the world is getting healthier, while we lag behind.
The United Nations has long had criteria as to what constitutes an “industrialized, developed nation”. There are currently 33 on that list. Of that number, 32 have Universal Health Care…all except the United States of America. Further, without exception, all pay through some sort of mandatory fee, tax or other compensation from all its citizens.
There are three basic methods of collecting needed funds so that all citizens get full health care: both preventive and treatment. And all three methods have been long standing and successful.
One is the Insurance Mandate, now being challenged in the Supreme Court. Among the nations that have such a plan, the most successful are several European countries (notably Germany with a highly regarded health care system). Very simply, the government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers; and if from private sources, no one can be rejected.
Some countries have what is called a “Two Tiered Plan”. The government provides or mandates catastrophic or minimum insurance coverage for everyone. Additional voluntary insurance or fee-for service care can be purchased if desired. Thus, the government provides a core policy which can be supplemented with private insurance. But everyone is covered. We attempted to employ a variation of that idea with the “public option” in our legislative health care debates, but that was quickly rejected by conservatives in Congress.
Then there is the Single Payer plan which about half the developed nations utilize. Again, rejected by conservatives, and badly mischaracterized as some sort of socialized medicine. The fact is, the actual medical care (with the exception of a couple of countries) is carried out by private providers. In short…your doctor. This is not unlike our highly successful and highly regarded Medicare system. Also, already government run, and widely accepted are the military Tricare and VA programs. And few complain about “infringement on personal liberty”.
So, while we clearly are out of step with the rest of the developed world on universal health care programs, what is often lost in this debate are the effects this has in the overall health of our nation. There are a number of ways to determine the “health” of a country, but perhaps the simplest one, and most easily defined is life expectancy. Notably, virtually every country (of the 32 countries referred to above) with universal health care, are in the top tier of longevity. The United States now ranks 34th on that list, according to the World Health Organization.
Another measure is infant mortality. According the 2009 CIA World Factbook which tracks such things, the United States is now 49th in the world in that statistic. But that is not the worst of it, because as far back as 1950, we ranked among the best in the world – now dozens of countries have passed us by. Even more distressing, with our continuing slide down the slippery slope of declining health care results, is the fact that we now have the most expensive health care system in the world.
Critics (and those who commenced the SCOTUS lawsuit), are now trying to find cover for scuttling the ACA under “Constitutional” grounds. While they may find success, it is widely acknowleged that such a decision will almost certainly be made by the court on political leanings rather than legal, as many of our previous 5 to 4 decisions have been in recent years. And that would be a significant loss for health care in America.
The Affordable Care Act is an attempt to redress the weaknesses that have existed in our nation’s health care system. It provides a mechanism whereby the 45 million uninsured (about 15 percent of our population) are afforded essential availability to health care. It employs a payment plan which has been successfully adopted by every other developed nation in the world – and no nation has ever reversed the plan or characterized it as unfair or unreasonable. It is based on the pragmatic premise that if each of us sacrifices modestly, there will be a greater good for the whole – and from that we too will end up being enriched. And that means we all will be living in a healthier, more vibrant, more robust America.