Universal Health Care in the U.S.?

Seminar 08 goals

Books & on the web

Drugs book content

Toward the abyss


Emergency in ERs

Quality & cost

Drugs & Insurance

EPI/ Lewin Health Plan













Seminar goal
To begin we list our concerns, our goals, and our values for a healthy society and for a medical system to support it. We discuss health care as a right. Using my experience of negotiating and managing contracts for services for the State of Texas — a system designed for accountability, quality, and low cost — we will explore options for government involvement in a health care system that is effective medically and efficient in cost for all people.

Quality & cost
We will check, review, and compare health care data in the U.S. and in other countries to evaluate American health care. We will explore the present cost of our medical system: insurance premiums, ER care truly ER and for non-emergency care for the uninsured, out-of-pocket payments, losses, private pay, coinsurance. Add defensive medicine and unnecessary testing that raises the cost. Add a system to quickly resolve differences that works faster and is less costly than litigation; litigation delays cause deaths, suffering, and disabilities.

Most industrial nations’ health systems negotiate for lower rates. For example, in the United States an MRI of the neck region costs about $1,500; in Japan the identical scan costs $98 and the Japanese labs make a profit. Costs of drugs varies widely among nations. As T. R. Reid says in his book, “Overseas strict cost controls actually drive innovation.” Many new pharmaceuticals we use came from Swiss, British, or Japanese labs and research.

Rationing of care
Rationing of care is a fact in the US based on what people can pay or insurance will pay after their rescission bureaucracy tries to cut coverage. Can we develop a rational rationing based on what criteria?

Three models
All industrial, developed nations — Europe to Japan — have health insurance for all. How they feel about their systems. America has a two tier system with many insured receiving what Arnold Kling calls "premium medicine" that uses more equipment and specialists, while a third of Americans receive poor care. Average all Americans in both tiers and we have poor quality care. The developed nations have three types of universal health care we will compare, using the criteria we developed in the early sessions:

  • Government operated health services are in Great Britain, Finland, Ireland, New Zealand, and Spain — this is the only one approaching "socialized medicine";
  • Single-payer national health insurance system as in Canada, Denmark, Sweden, and Australia; insurance is publicly administered and most physicians are in private practice—similar to American medicare; and
  • Highly regulated universal multi-payer health insurance systems are in Germany, France, Holland, Italy, and Japan. They have universal health insurance or funds that pay physicians and hospitals uniform rates that are negotiated annually. Physicians not on hospital or university staffs are in private practice.

We will review the present health insurance industry — under-insurance, pre-existing conditions, and other obstacles. Is it true that a large part of insurance staff exist to deny coverage and that “medical losses” is the insurance term for paying insurance claims?

Universal health care will come only after major obstacles are overcome. We will review those obstacles participants say they want to consider, and consider the effects of three major factors:

  • insurance industry,
  • pharmaceutical industry, and
  • the political process.


  • Free 12-grade quality education has been a right for all children for a century or more; should health care be a similar right?
  • Medical care is costly; should health insurance premiums or co-pays be linked to income, so the wealthy pay much of the cost of basic care?
  • How much can information technology reduce the cost of medical care — as the smart-cards in Taiwan?
  • Should health insurance pay only for catastrophic and other major medical costs, but working families in poverty cannot afford basic care?
  • How much is spent on defensive medicine? What fast, effective, patient-centered ways can eliminate lawsuits.

Copyright © 2008 John F. Yeaman

Added web site information September 2009 about current proposals and arguments links & sites:

Health care reform glossary: http://www.webmd.com/a-to-z-guides/health-care-reform-glossary

Center for media & democracy: http://www.prwatch.org/node/8422

Kaiser comparison of plans: http://www.kff.org/healthreform/sidebyside.cfm

Dartmouth study of spending variations: http://www.dartmouthatlas.org/





Arnold Kling's Crisis of Abundance: rethinking how we pay for health care discusses premium medicine and other aspects and issues of health care, including policy and other proposals.