One of my doctor cousins is married to an Italian man, M, whose family still lives in Italy. Recently, M's elderly father was in a car accident and sustained pretty severe injuries, including head trauma and a broken hip, which required several hours of surgery. Despite the fact that he had major surgery and was already in less than perfect health (he has a history of heart problems and severe arthritis), he was released one day after his surgery. Naturally, this was a cause of great distress to my cousin and her husband.
What I was able to discern from talking to my cousin was that in Italy, which has a single payer system, hospital beds are very hard to come by. So although everyone is entitled to catastrophic care (and illness care), the resources for recuperative care is almost non-existent. Despite the fact that my cousin’s family is solidly upper middle class (iow, they have money and would have gladly spent it for their father’s care), every avenue they pursued in terms of looking for on-going care basically dead ended. Finally, having run out of options, M (also a doctor) jumped on a plane to Italy and spent almost 2 weeks there to retrofit his father’s home with appropriate medical equipment and train his brother so that the brother would be able to provide the kind of basic post-op care that they could not hire.
Now I know that for certain critics, this is sufficient justification to disqualify the entire proposition of universal health care. What insincere bollocks. While I’m sure that the citizens of single payer countries find it irritating and aggravating that they cannot get the standard US two/three days post-op recovery, they are probably also pretty damn happy that they never have to question whether basic preventative and illness care will be available to them. Ultimately, it’s hard to be pissed at the system that guarantees your right to live.
So why bring this up? Well, one of my biggest pet peeves is the problem of economic disequilibrium, which tends to show up when there is a great disparity in wealth distribution. Specifically, the trend in America over the past 25 years towards a greater concentration of income at the very top. For me, the fact that inequities will arise even under a universal care system is the reason that I believe that policy-makers must take some responsibility for bringing the wealth disparity in America back to some sustainable balance.
Under a single-payer system, one of the necessary side effects will be a universal determination of the type of treatments guaranteed under such plan. For example, it is likely that widely accepted treatments like chemotherapy and most proven life-saving surgeries would be officially sanctioned. However, more experimental or controversial treatments would not. And unfortunately, situations like Kyla’s, where there is clearly a medical issue but the doctors are either uncertain or have conflicting views about the cause(s), may not benefit from a single payer plan, as each specialist and his/her course of treatment will be questioned for relevance and efficacy as the extent of coverage is determined.
Under these conditions, the economic disparity in America will become ever more apparent: as the more esoteric but potentially effective treatments are not picked up under universal health, such treatments will become privatized, either domestically or abroad. Without the benefit of negotiated prices provided by private insurance, it will increasingly be the case that only individuals with high net worth will be able to afford certain kinds of care domestically, or more dramatically, be able to airlift themselves or their loved ones to other countries where such care is available, though at a price. Like my cousin’s case, it will no longer be enough to simply have the kind of money whereby you can afford higher education for your children and a nice car in the garage, but you would have to literally have enough money to afford a private jet, a private room, dedicated health care professional.
I can offer no solutions to this innate dichotomy in the single payer system: that in the process of guaranteeing quality health care to all, you may at the same time be guaranteeing that the best health care becomes available only to the few. The health care plans proposed by the democratic candidates, a mix of public and private insurance, prevents this concentration of superior care. But as I mentioned in my previous post, I'm not certain that the mixed system will be cost-efficient which may prevent its implementation or jeopardize its longevity. One option may be a split system, with universal single payer coverage providing standard care to all Americans and a smaller strata of private insurance providers who will insure middle and upper-middleclass families for premium coverage. This will still be inequitable, a distinction between the haves and the have-nots, but at least it is one that seems realistically achievable for the many. It is the kind of inequality bridgeable with sweat and hard work, palatable to a nation that still promises itself to be a land of opportunity.
Cross-posted at Momocrats.
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