Moderator Tom Brokaw's question in the second presidential debate crystallized the crux of the health-care reform discussion: Is health care in America a privilege, a right or a responsibility? The candidates' responses are an example of the ambivalence and lack of clarity many Americans still have regarding this question: Sen. Obama declared it unequivocally a right, while Sen. McCain answered less clearly about a "responsibility" to have affordable health care available for all citizens.
There are two compelling reasons to insist we provide health-care coverage for all Americans: It is the moral, ethical thing to do for our citizens, and we can no longer economically afford not to do it.
First, there is a powerful moral argument to provide coverage for everyone. In a country as wealthy as the United States, access to health care should now be viewed as a basic right. There are rights that have been thought of as unassailable natural rights from the founding of our country -- for example, our Bill of Rights. Other rights such as women's suffrage or civil rights for African-Americans have required struggle, sacrifice and a changing of the public's perception over time of what constitutes a right.
The perception that health care is a basic right has become the majority view in our country. Seventy-two percent of Americans now strongly believe that health care "should be considered a human right." (Public Opinion Research on Human Rights in the U.S., 2007) Among physicians, the tide is turning, too. A survey by Indiana University found that 60 percent of physicians support government legislation to establish national health insurance -- a 10 percent increase in such support since 2002.
We are virtually the only Westernized modern economy that has failed to provide health care for its citizens. If the United States is to maintain its moral standing allowing us to trumpet equal rights and freedom for all the world's citizens, we must begin by taking care of our own citizens.
Second, the economics of our health-care system have reached a breaking point. The United States spends twice as much as other industrialized nations on health care per capita. We spent 15.2 percent of our gross domestic product on health care in 2003 -- the next closest industrialized country (Switzerland) spent 11.5 percent, while Great Britain spent just 7.8 percent.
This spending gives us the best care in the world, though, doesn't it? Actually, the World Health Organization ranks the U.S. health system at number 37, just below Costa Rica. We still have 47 million Americans without any insurance, and countless more are uninsured. Even those with insurance have seen their premiums, drug costs and co-pays rise dramatically over the last several years.
If one is not swayed by the moral argument, at least consider the economic one. We all pay for the uninsured already. Those patients without access to a medical home simply clog up our emergency rooms with non-urgent matters. Patients without good chronic disease management for their diabetes, heart disease and high blood pressure end up having catastrophic heart attacks, strokes and medical procedures that cost our system billions of dollars annually.
These costs are passed on to those with health insurance through higher premiums. Why not provide insurance for everyone up front, guarantee all Americans a medical home with a primary-care physician and work toward preventing these expensive outcomes?
Private insurance bureaucracy and paperwork consume 31 percent of every health-care dollar. For those who believe the government can never do anything more efficiently than the private sector, consider that Medicare operates with just 3 percent overhead compared to the 15 percent to 25 percent overhead of a typical private insurer.
As a primary-care physician, I can vouch that our health-care system has the most compassionate, competent and professional people I have ever known. We need to craft a system that allows these talented individuals to spend their time and energies caring for their patients, not bearing the burden of unnecessary administrative costs or worrying about how to care for patients who don't have the means to pay for service.
Winston Churchill famously said, "You can always count on Americans to do the right thing -- after they've tried everything else." We have tried a pure market model for health care, and it has failed us. In this election season, as we pin our hopes on a new presidential administration and new Congress to lead us, let us demand of our leaders a meaningful attempt to solve our health-care crisis. We can no longer afford morally or economically to keep things the way they are.