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This, I believe, is the question that must be answered in order to determine the future direction of health care management in the United States.

Political debates regarding health care reform and, in particular, the prospect of ‘universal’ health care in the US are frequently brought to an abrupt halt when someone utters the phrase ’socialized medicine’ when meaningful discussion emerges regarding universal health care.  Based on the historic growth of the US through the ’strength of the market’, it is assumed by many that this approach must also hold the promise of delivering health care to all US citizens.  However, this mode of thinking is fundamentally flawed.  I would argue that guarantee of a fundamental human right CANNOT be left purely to market forces without regulation ensuring that the market deliver the service/product/’right’ to the entire populus.  This, I believe, is why the US must collectively decide how we, as a nation, are going to view health care; as a luxury or a right.

Currently, it is treated as a luxury in this country, if by no other measure than the fact that 15-20% of Americans have no health insurance, and so must pay for care out of pocket.  This intrinsically limits the level of care available to this proprotion of the population, particularly given the every escalating costs of care.  In other words, chemotherapy, to the uninsured, is a luxury: some can afford it, and some cannot.  To state that our society considers it a human right would also be to say that we are violating the fundamental human rights of 15% of our own population, something I believe no incumbent politician would be willing to acknowledge.

Similarly, health coverage for employees is considered a ‘benefit’, and an increasingly scarce one at that.  Can we truly state that we consider health care to be a human right if it is a ‘benefit’ and not a requirement?

We also comfort ourselves by claiming that though we pay more per person than any other country by 3-fold, despite insuring only 85% of our population, we have the highest quality health care technology in the world, and therefore our system is the envy of ’socialized’ systems.  Yet for all that expenditure, we CONSISTENTLY fall far behind every other industrialized nation in nearly every major indicator of health used by the WHO (eg life expectancy, infant mortality, even age-adjusted mortality).  In 2006, we remain ranked < number 40 in the world in life expectancy, notably behind nearly every member of the EU.  We did finally pull ahead of Bosnia (whom we were several places behind up to 2004-2005).  What does this indicate about our hallowed market-based approach?

Of course, a solution to this is not easy. Over the past 30 years, reform advocates such as Victor Fuchs and Alain Enthoven have proposed intriguing models that have been adopted by states and even whole nations as viable alternatives to our present system, and even encourage competition and innovation while delivering some degree of health care to whole populations.  Yet we continue to flounder with providing care to our own citizens, and none of the major challenges present when they began their work have been really solved…  at the heart of this is this continuing internal and largely unspoken conflict:  do all people deserve health care or do only the fortunate?   Until our society and reconcile this question, there will be no meaningful progress.

Where to start talking about our health care situation?

Of all the issues, the one that is coming to my attention lately is the way “pre-existing conditions” are used by insurance companies. I have individual coverage for my health care, but not regular individual coverage. I have a “portability” policy because of some preexisting conditions the company feels puts them at additional risk which means my policy costs much more than an individual policy, and vastly more than a group policy, but no doctor visits, lab tests or preventative screening are covered until my entire deductible is met.  The fact that my conditions require no medical care other than routine medication apparently does enter in to the equation. Bottom line: by insisting on portability my insurance company gets a lot more money from me while providing inferior coverage, and that apparently is the law. I have applied to other insurance companies and was turned down for different reasons but the same net result: expensive high risk policy. I thought it was just me, that my situation was unusual, that I just fell through the cracks.

It turns out, however, that this is going on all over the place.  Friends and neighbors tell me their situation, that they too are locked into one expensive option. No choice, no competition. It is Take it or Leave it. These same companies do not discriminate against people when they insure groups. They take on everybody in the group. But outside a group If you need individual coverage, you are generally designated high risk and charged sky high premiums.

We are all worried about the increasing number of people who are uninsured and this is one big reason why.  With increasing numbers of people losing their group coverage, affordable alternatives must be made available. It is no longer a matter of waiting out a period of time before a condition is covered. Almost any condition can now be used as a permanent excuse to keep an individual in the high risk pool and exploit that situation to get excessive premiums. People in this predicament do not have lobbyists to negotiate on their behalf.  Must we wait for the federal government to fix this? Or is there anything individuals can do? I am open to suggestions.