Greed, Fear and Other Barriers to Health Care as a Human Right

Of all the wealthy countries, only the United States has so far failed to treat health care as a human right. A human right to health care means that everybody receives the same health care whatever their age, gender, health or employment status, racial or religious background, sexual orientation, or wealth and income level.

One reason I often hear cited for our failure to join all other wealthy nations in making health care a human right is that we can’t afford it. Some argue, “We’re already spending too much on health care and cannot afford to expand coverage to everybody.”

They have it backwards. Our failure to expand health care to everybody is a major cause for our high costs, not a reason for not doing more. Slicing and dicing our population into “risk categories” (the fundamental business of the commercial insurance industry), having thousands of different insurance companies (all with their own rules), then arguing about who pays what is very expensive.

The Institute of Medicine recently reported that around 25 percent of the approximately $3 trillion we spend as a nation annually on health care is wasted. Much of this waste is traceable back to the way we pay for that care, segmenting the population into categories and paying for them separately: the elderly, the poor or near-poor, the employed, the unemployed, young people, sick people, well people, veterans, Native Americans, and so on.

Each category and its attached financing pool receives its own treatment — range of benefits, prices, utilization review programs, amounts of co-pays and deductibles and more. This complexity is very costly, not only for the private insurers and public programs, but also for doctors, hospitals and health care systems to administer.

I recently heard the CEO of a large Medicare Advantage plan in Maine say that he could cut his overhead by 50 to 60 percent if we reduced the number of payment plans he had to deal with to one. He then went on for the first time publicly to endorse a universal plan for Maine — everybody in, nobody out of the same plan.

Our system of financing health care in the U.S. leaves many people without coverage (about 35 million in the case of Obamacare, even in the unlikely event everything works perfectly), leading to high rates of avoidable human suffering and personal bankruptcy. Obamacare is far too complicated, as was Maine’s ill-fated Dirigo program. Both made the mistake of trying to build on our current, badly flawed employment-based health insurance system.

Obamacare’s rollout is already over budget and behind schedule, mostly because of its complexity. Maine’s Dirigo program is on life support and slated to be phased out. I’m afraid their problems are only going to get worse.

Other countries figured out long ago that simplicity works and as a result have health care systems that cover everybody, get better results than we do for most health outcomes, are far more popular with both their publics and politicians, and cost about half of what ours does.

As a physician, I have always thought that health care should be a human right. I believe there is a strong moral argument for health care systems that cover everybody. There is now a strong economic argument as well. Overwhelming evidence exists from all other wealthy countries that a simpler and therefore more efficient system is much less expensive and more humane than ours.

So why don’t we just go ahead and simplify our system by expanding Medicare, a program that is overwhelmingly popular with the U.S. public, to everybody?

When I’m asked this question, I think of “A-FIG:”

— Apathy on the part of the protected classes. Those of us employed by large businesses, highly paid executives and some union workers who enjoy good (and heavily tax-subsidized) health insurance. “I’ve got mine.”

— F ear of losing what we already have, if we are consumers of health care, and of losing our (sometimes excessively high) incomes, if we are individual or corporate providers of health care.

— Ignorance on the part of most Americans about how our health care system now works, that other nations have better health care systems than ours by almost all measurable outcome criteria, and that our health care system could be much better here, if we had the political will to change it.

— Greed on the part of lots of people (most of them corporate “people”) who are enjoying windfall profits and would like to continue doing so from our present disorganized, poorly regulated and opaque system.

We could do much better. As more of us question the status quo and understand how health care as a human right can become a reality, reasons for not doing so will dwindle to nothing.