The US has taken a giant
step in providing universal health care for its citizens, but amidst the
rejoicing, it would help the protagonists to look at the experience of other
nations who have been providing universal health care for many decades. “Poena
dare” Latin “to pay the penalty” is something we will be often confronted with
as we get down to the nitty-gritty of what care to provide and how to finance
Some countries provide
health care financed out of tax income others expect citizens and employers to
share premium expenses and some put the entire burden of paying premiums and
even part of the expenses on the individual, with the caveat that insurance
firms are obliged to provide basic coverage to everyone. Each system has its
advantages and disadvantages. Some, such as those that require no personal
contribution and are financed by tax income, have elements of strong rationing
of services, where one will have to wait for months if not years for treatment.
Others have increasingly passed on the expenses to the insured, where some of
these added expenses can lead to financial debility.
The commonality that
all these systems share is the increased cost of providing health care and the
unpleasant fact that unless these costs are reduced either the government steps
in and further subsidizes expenses or the insured bear a greater share of the
expenses. We are already faced today with a dilemma that will become even more
acute in the years to come. Faced with the unpleasant issues of life style,
eating habits and general way of life and the way these directly influence our
health – let alone the far greater issue of genetic preponderance, we will have
to define what is considered to be acceptable and what is
exceptional and requires to be charged extra. The airline industry uses an euphemism for one
factor with the term “passenger of size”.
If one wants to buy a branded
bag from Hermès, one must be willing to pay for it. And with medical care, here
begins the fine line between what is essential and can be financed and what is
not included. Health insurers are not necessarily demons in this game and we
all represent our own interests.
Open societies must be
willing to discuss and contemplate the issues at stake here and be willing to
face some unpleasant truths. Otherwise the issues that we sweep under the
carpet will come back to haunt us and prove those nay-sayers, who willingly had
their grandmas smothered under those tea bags, right at the end.