Comments on: Sick Around the World

Of all the pressing domestic issues in this election year, a successful resolution of the problems in healthcare will have the most enduring effect. Any effort to clarify the issues involved therefore deserves thoughtful consideration. “Sick Around the World,” presented by Frontline, does attempt an even handed comparison of universal care in five countries. Its premise is that among these programs we may find useful suggestions to apply to US medicine. In his summary the narrator, T. R. Reid, identifies three common practices used by these nations to organize their healthcare. First, insurance company profits are limited or eliminated. Second, everybody is mandated to buy healthcare. Government must then provide subsidies to the poor. Lastly, providers (hospitals and physicians) must accept fixed prices.

These practices can be restated as basic principles for any system of universal care. There must be a mechanism to average cost. Funding must include everyone. There must be some fiduciary responsibility built into the distribution of care.

Implications of these principles.

The restrictions on profit essentially preclude all consideration of expansion of the system. Indeed, governments have disincentives to expand the flow of money into healthcare. The prime example is Taiwan which, according to the Frontline report, now realizes that it has underfunded healthcare but lacks the political will to correct the problem.

Moreover, by choosing to eliminate profit they must now rely upon controlling cost to sustain their systems. But this exposes an economic reality. Cost never defines a market. Profit, the balance between supply and demand, of necessity also includes the legitimate interests of the consumer. Without profit healthcare becomes a one-sided marketplace serving only the needs of tax-funded governments or their surrogate insurance companies. They exercise fiduciary responsibility through external measures of control imposed by none participants in the actual use of the services. Their purpose is to protect the interests of the funding source.

Under these circumstances the mandate to include everyone seems less appealing. Elimination of services is a usual measure of control in these systems. As documented elsewhere on this site Great Britain has refused to pay for some vital cancer chemotherapies. The arguments given for these omisions are immaterial. These are therapies recommended by experts in the field with the intention of saving a life. Under such circumstances, if an individual finds that his needs will not be met by the system, then the system no longer exists for that individual and the claim of universal coverage is false.

Lastly, imposing fixed prices upon providers creates a system of de facto rationing of services and places physicians into involuntary servitude. These systems do continue to function because of a peculiar characteristic of physicians. They believe that their primary responsibility is to their patients. In all these countries the profession’s dedication to patients goes well beyond any consideration of personal gain. But is there any moral justification to this exploitation?

How in America?

If the methods of other countries could be so easily applied to America then we would have accomplished universal care long ago. But we are a unique people with a strong sense of independence and belief in our freedoms. Devising a system of universal care which remains true to this character is, and will be, a formidable task.

When examined more closely it becomes apparent that the systems reviewed in this program are designed for the healthy while cost savings are trimmed out of the needs of the truly sick. Before we embrace the common practices of other nations we need to re-examine our own values.

This brings us to what ought to be the primary question. What is healthcare?