Should the US have universal health coverage?

A relatively new web site – Opposing Views – serves as a platform for debates on various issues.  The debate categories include health.  They asked me to participate in a debate on universal health coverage.  So here is my take.

The question posed can serve as a Rorshach test.  I could just as easily debate one side as the other.  So I have difficulty deciding if my response is pro or con.  Given the non-specificity of the question, I will alter the frame to one I can endorse.

I would like to have some level of health coverage for all US citizens.  De facto, we have emergency coverage and hospitalization coverage.  We cannot turn patients away from the emergency department.  If the patient has medical need for hospitalization, we must provide care.  We cannot "dump" the patient to another hospital.

But that is not the question we should answer.  Would we as a country benefit from a form of universal health coverage?  I would point out that the question does not imply a single payer system.  Rather should we develop a minimal health coverage that all should have.  Should we adopt a version of the Massachusetts plan?

We could argue this question as a moral issue.  Some would argue that health care is a right.  Calling health care a right raises another interesting debate.  That debate involves semantics and definitions.  I would prefer to avoid the moral debate, and view this question more pragmatically.

We have much data on the value of primary care.  I refer to this definition: "A set of attributes, as in the 1978 IOM definition—care that is accessible, comprehensive, coordinated, continuous, and accountable—or as defined by Starfield (1992)—care that is characterized by first contact, accessibility, longitudinality, and comprehensiveness."  Our current payment scheme does not encourage physicians to enter the field. 

So I would like to see universal health coverage for true primary care, as I believe that investing upstream would decrease costs downstream.

We already have de facto hospitalization, so we obviously should encourage formal coverage for hospitalization.

How can we afford such a plan?  I will argue that we can only afford universal health coverage if we adopt some capitalistic principles.  Such a plan will only work if the patient has appropriate responsibility for health care costs.  We could prorate their share of any diagnostic testing, hospitalization or drugs. 

Having patients involved financially in decision making  should help physicians with several discussions.  First, patients often want an expensive diagnostic test.  If I believe that the test is not truly indicated, then I try to convince the patient not to have the test.  Involving money in the discussion only works if the patient is actually paying a portion of the costs.  Second, this strategy would encourage patients to use appropriate generic drugs.  When patients have responsibility for drug costs, they become very interested in $4/month prescriptions.  Without this incentive, they will often want a drug that they have seen advertised on television or in magazines.

So with many caveats I favor universal health coverage.  I believe that the investment would ultimately save societal resources.