In defense of universal health care

(and why the U.S. health care reform bill misses the mark)

In the heated debate prior to the U.S. Congress passing its health care reform bill earlier this year, a great deal of disinformation poured forth from the media. One blatant misrepresentation of the reforms was the portrayal of Barack Obama’s “health insurance for all” proposals, and the bill that ultimately passed in Congress, as universalism in action. There’s nothing universal about an insurance-based system, and Canadians concerned about the future of medicare would do well to understand the problems inherent in the American system.

Insurance, by its very nature, is not based on universality. It is based on risk assessment, and the rates are set such that insurance corporations will always show a profit, unless some unforeseen event sideswipes them. When you buy insurance, premiums are essentially a bet that you will get sick or hurt. The insurance company bets that you won’t get sick, hurt or disabled, and the premiums they collect cover not just the projected cost of your health care but also their own bloated administration budgets and the profits they distribute to shareholders.

Americans spend almost twice as much on health care, per capita, as Canadians. It’s the fear of losing one’s shirt as a result of uninsured illness or injury that keeps people playing against the odds. On an individual scale, hedging against health catastrophe may make sense, but as a foundation for funding a nation’s health care costs, it’s a recipe for failure.

In the midst of the greatest conflagration of capitalism in generations, President Obama initially tried to remove health coverage from the insurance casino floor and develop a more rational, equitable health care system, but he was defeated by the insurance lobby in Washington.

American insurance corporations grudgingly supported President Obama’s watered-down proposals, which stop well short of universality, and the Patient Protection and Affordable Care Act was passed by Congress on March 23, 2010.

Obama’s turn away from universality is at least partly explained by the very large corporate insurance donations he received for his nomination and election campaigns. (As, incidentally, did Hillary Clinton.) No matter who won the presidential race, due to the power of the insurance lobby there was almost no chance of a truly universal, single-payer health program for the American population.

The principle of universality makes sense and is worth fighting for. In Canada and Europe, tax-based, egalitarian public health care programs are popular with the vast majority of citizens. Policy-makers favour universality because, when implemented properly, it satisfies everyone – rich and poor alike receive good quality services, and sharing costs among the whole population keeps these services affordable. The broad appeal of a universal system has driven improvements in health care for those with wealth as well as those without, for whom health care services would otherwise be out of reach. Universal programs are administratively straightforward, with low overhead costs, while insurance programs are complex, expensive and wasteful.

Granted, Canada’s medicare system is far from perfect and certainly needs some amendments and updates. But a move away from universality toward an insurance-based system is a step in precisely the wrong direction and would result in more expensive, less effective health care.

The governments of Alberta, British Columbia and Quebec are leading the way in undermining the Canada Health Act, the foundation of medicare, and promoting the privatization of public health services. Other Canadian provinces and territories are pursuing some of these trends as well.

This despite poll after poll repeatedly showing massive public support for universal medicare. Canada doesn’t need an insurance-based health care system and our citizens know it. The principle of universality – the idea that health care is a right for everyone, regardless of means – needs to be defended, and the creeping encroachment of the medical insurance model in this country must be confronted head-on.

Ken Collier is a retired professor of social work living in Red Deer, Alberta. He is active with the Council of Canadians and Friends of Medicare (Alberta) and writes for progressive activist and research publications.

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