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The State (South Carolina)

Focus on Justice Makes Health Solution Obvious

Paul DeMarco

Although many have complained about the tenor of the current health care conversation, this is the way Americans have settled matters since the founding of the republic: Our national debates always have been more like full-throated arguments after a few beers than refined cocktail party dialogue.

When Americans disagree, hyperbolic claims come naturally and are greeted with cheers, groans, applause or derisive laughter — everything but surprise. But soon, very soon, if we are to get ourselves on the right track, we must quiet the nay-sayers and the fear-mongers and give the voices of wisdom the floor.

In previous times of crisis, the wisdom of our leaders has pointed us toward justice. We had President Lincoln to remind us of “the better angels of our nature,” President Kennedy to exhort us to put country above self and Dr. King to admonish us to “live together as brothers or perish together as fools.”

At its core, our health care debate is also about justice. Unlike most developed nations, we continue to treat health care as a commodity. We ration it (no nation has the resources to meet all its citizens’ health care needs), but we ration capriciously, by income and employment.

Ironically, the cure is right at our fingertips: Simply expand Medicare to all Americans. Canadians, who cover all their citizens with a system similar to our Medicare, point to it as a source of national pride. In the ’60s, they recognized that justice was the first principle to be addressed in health care; once they decided that no citizen should go without reasonable access to medical care, they were well-positioned to face the difficult but not insurmountable questions about what should be covered and how to pay for it. While it is clear that the Canadian system has its problems, there is little doubt that taken as a whole it is better for the average citizen. The Canadians achieve similar overall health outcomes as the United States while spending just over half what we spend.

Are there Canadian health horror stories? Certainly, but America has no lack of those herself. More to the point, anecdotes shouldn’t be the basis for health policy. The United States would have to address legitimate concerns such as waiting times and access to specialists if we adopted Medicare for all. But universal coverage will immediately improve the lot of the many hard-working small-business people with chronic diseases who are floundering without health insurance. My barber is a perfect example. He’s one of Main Street’s most solid citizens. His shop lights are already on when I drive by in the early morning, but he must rely on charity care because as an owner-operator, he can’t afford a health policy. His plight does not exist in Canada.

Americans are rightly skeptical of government and wary of our recent deficit spending. But the notion that publicly funded health care is a new and radical idea for us is nonsense. Medicare, Medicaid and the Veterans Administration are all federally funded single-payer systems that have been in place for decades.

U.S. Medicare alone covers 45 million people — 12 million more than the entire population of Canada. Some seniors are so comfortable with Medicare they seem to have forgotten it is publicly funded; at town meetings, they have argued against the public option as unacceptable government intrusion while at the same time singing the praises of Medicare. And although the empty claim that government-funded health care would be bloated, intrusive and inefficient has been repeated incessantly, the truth is that U.S. Medicare achieves satisfaction rates similar to private insurers while operating with roughly a third of their overhead.

President Obama has missed his opportunity to lead on this issue. Rather than framing the issue as one of justice and declaring it unacceptable for any American to go without decent health insurance, he has opted to placate the insurers, drug companies and for-profit hospitals whose focus on the bottom line has warped the system.

It’s hard to imagine that Dr. King would be satisfied with Obama’s half measures. Dr. King knew that justice often required bold action and sacrifice by the privileged. In the absence of a spokesman of his stature, the uninsured and we who stand with them must take up the mantle ourselves. Contact your representatives with the simple message: “I’m for Medicare for all.” Join Physicians for a National Health Program (anyone can join; you needn’t be a doctor). Fight for health care justice.

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Dr. DeMarco, a Florence physician, is a member of Physicians for a National Health Program. Contact him at

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