Why the US Government Should Not Adopt a Universal Health Coverage Program

Page 62 The California Journal of Emergency Medicine V:3, Jul-Sep 2004 Why the US Government Should Not Adopt a Universal Health Coverage Program Lance Montauk, MD Assistant Clinical Professor Emergency Medicine UCSF Attending Physician Emergency Department Alta Bates Medical Center make them the all-powerful bureaucrats, rationing out benefits, since only doctors will be qualified to judge “medical need.” The concept of objective “medical need” is hogwash. There are only endless health conditions (and endless abilities to treat them) ranging from abysmal disease- ridden malnourished impoverishment through bizarrely “health conscious” California fitness-freaks, to asymptomatic illegal Guatemalan workers digging drainage ditches, to asymptomatic Silicon Valley magnates wanting yearly whole-body scans during their “executive” physicals. The “needs” of those individuals is—and always will be—an entirely subjective matter. b Principle #1 that I disagree with: “Access to comprehensive health care is a human right.” Our Founding Fathers have already spoken on this subject. c Our country was founded on the rights of “life, liberty and the pursuit of happiness,” rights such as the free exercise of religion, freedom of speech and the press, freedom of assembly, the right to bear arms, the right against unreasonable searches and seizures, etc. d Frustratingly, in California, state prisoners have more rights to—and probably receive better—health care, than many of our non- incarcerated inhabitants, because of court holdings that failure to provide comprehensive health care in prison is equivalent to cruel and unusual punishment! Thus we have examples of felons in prison receiving $2,000,000 heart transplants (which failed)—a good example of how the so-called “right” to comprehensive health care goes awry. e Or consider our national dialysis policy.... I accept that access to basic health care is an important human need, and major steps towards realizing these health care needs include provision of: 1) sanitary sewer/potable water systems; 2) adequate nutrition; 3) vaccinations/immunizations; 4) contraception and sexually transmissible disease control; 5) prenatal and childbirth care. These essential public health matters remain far more cost effective than the boutique “comprehensive health care” most California doctors provide and the JAMA article belabors us about. The elitist creation of “comprehensive health care” “rights” Doctors know government and politics like lawyers know medicine—enough to really make a mess of things. Thus, physicians loath to recommend major surgery (especially of debatable benefit) for their patients, eagerly advocate for radical “reform” of our health care system, even though the body politic also bears lifelong scars after disfiguring interventions. Why do doctors, so distrustful of the federal government which brought us the Abu Ghraib prison debacle, the CIA, the IRS, and the erstwhile INS, paradoxically support handing over health care to these same politicians and bureaucrats? What do they mean by “Universal Health Coverage Program” (UHCP)? Start with the JAMA “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance.” 1 This startlingly sophomoric, markedly vague, utopian socialist vision, rests on a basic proposition, purportedly supported by four “principles.” Two of those principles are erroneous, one is irrelevant, and one actually shows why we should not strive for UHCP. The basic Socialist proposition The quote from JAMA: “The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need.” This of course should sound familiar: “from each according to his abilities; to each according to his needs.” a In this case, however, the appeal to medical professionals is clear: