Although not perfect, U.S. health care is generally practiced at a high level.
Thousands of students come from around the world to learn here, which is testimony enough.
What is at the core of the health care debate is the unaffordable, dysfunctional way in which we as a nation are now paying for care, which in turn directly affects the extent to which it is provided.
One of the most basic issues is some 45 million Americans still do not have health care coverage. The underlying core question is: Is access to health care a fundamental right?
No, it is not in the Bill of Rights. Yes, in an economy built on free enterprise, there is no such guarantee.
But consider these facts:
Fact Box
Dr. Clyde Nash of Boca Grande, professor emeritus at Case Western Reserve University School of Medicine and the MetroHealth Medical System in Cleveland, can be reached at (216) 554-2070.
1, U.S. laws require the nearest hospital to provide emergency life-saving care to any person requiring it. Many communities have already established "safety net" hospitals. So practically speaking, almost every American is medically covered to a degree
2, Our country is founded on the innate value of the individual as expressed in the concept of freedom and the phrase "All Men are created equal
3, The Hippocratic Oath to which all physicians pledge commits us to care for all in need despite ability to pay. That is why physicians willingly sign up for six to 10 years of education, training and sacrifice. The vast majority of caregivers believe in this simple principle.
The United States, of all countries, should adopt this basic humanity and probably would have long ago had the issue of cost not prevented it.
Looking at this lack of coverage from an economic point of view, it is apparent that an actuarial disconnect is at the core of the nation's cost problem. Those who do have and are paying for some form of health care coverage are paying for health care received by 40 million-plus underinsured people. And by coverage we mean private and publicly funded.
Therefore, a significant numbe4r of people who receive health care do not pay for it either directly or through payment of taxes.
Before condemning all non-payers, let's look at the reasons for their situation by noting the ways our system works against solving this actuarial disconnect.
The working uninsured make up a considerable portion of non-payers. For them, the cost of buying health care coverage is prohibitive. Someone making $9 an hour at Wendy's is not going to be able to pony up the minimal entry cost of $250 to $300 per month for health care. Plus, many of these are young, healthy and logically see no reason for taking on this heavy financial burden.
The unemployed or using an employer health care plan can go on Medicaid but must meet stringent poverty level requirements. These are becoming tighter as the Medicaid rolls swell.
At the other end, most seniors do pay for and receive health care through Medicare. Unfortunately, many seniors, for some reason or another, do not have such coverage. Of even more concern for this group is payment rates for Medicare providers have declined to the point a majority of doctors and providers are not accepting new Medicare patients or not accepting Medicare patients at all.
Mayo Clinic recently stopped accepting Medicare at a number of its outpatient facilities and other systems are either following suit or contemplating it.
Most seniors, with fixed retirement incomes increasingly squeezed by rising costs, can ill afford to pay more for health care coverage.
They are at serious risk to swell the ranks of those who cannot afford to pay for health care. The irony is this group consumes a disproportionate share of health care costs.
In summary, a case can be made for why every citizen should and probably would have access to health care assuming we as a nation could afford it.
Looking further in the supply side issues of paying for health care, a number of forces are at work keeping costs high for those who are paying and blocking millions of others from obtaining care and paying a share of the costs.
Just think how much progress we could make if we could figure out a way for each and every citizen to contribute something toward his or her health care. It can be done.
We must look at the ever-rising costs of health care that constantly outrun the national cost of living index. Efficiencies and effectiveness have become critical as the squeeze of rising costs has reached a breaking point in health care delivery.
For all its ability to solve free market economic equations, competition has repeatedly failed to do so relative to keeping health care costs down and providing widespread coverage. Governmental control and programs have proven as unsuccessful as private sector plans.
