Speaking Out for Universal Health Care

From the Preamble: "We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, …promote the general Welfare, … do ordain and establish this Constitution for the United States of America." From the Pledge of Allegiance: "…with liberty and justice for all."

Do these words resonate with you, my colleagues in the health care profession? If so, then justice demands that health care be considered a right.

Wisconsin boasts that among the states, it ranks very high in claiming low numbers of uninsured. But this is a hollow claim. Depending on what statistics you read, there are anywhere from 300,000 to 500,000 people in this state who do not have health insurance. These figures do not include large numbers of recent immigrants, especially Latinos. The number of uninsured will grow with the expected rise in unemployment, the rapid increase in insurance premium costs, the anticipated continuing downturn in the economy, and employers' insistence that employees pay the a greater portion of insurance premiums.

We in Wisconsin speak with pride about the quality of care we provide patients, the advances in technology, the skills and training of our health care professionals, and the caliber of our medical research. But when we carefully examine overall health statistics in the state--infant mortality, length of life for both men and women, the incidence of cancer, heart disease, hypertension--we should be shocked by the disparities between those who are insured and those who are too poor to afford adequate health care. In 1998 the infant mortality rate among African Americans in Wisconsin was three times that of whites, exceeding the national disparity.

Limiting insurance coverage is costly in many ways. According to a statement by Dr. Arthur Kellerman of the Institute of Medicine, "Our system of health care coverage functions more like a sieve than a safety net, with more and more people slipping through the holes. Having health insurance is critical to accessing preventive and routine health care services. Without coverage, roughly 40 million Americans face steep barriers to care and an increased risk of serious illness."

Most of us recognize the grave shortcomings of our administratively top-heavy, highly fragmented, inequitable system of health care, which once again shows cost escalation in the double digits. We see the necessity for major change, but can't agree on an approach to providing health care security for all.

Some pertinent facts must penetrate our awareness: Ours is the only country among the industrialized nations that considers health care a for-profit commodity to be sold to those who can pay, the only country that does not have a form of national health insurance covering virtually all its people. The enormous Medical Industrial Complex--including insurance companies, pharmaceutical companies and the American Medical Association--has fought the concept of a national health insurance for over 92 years. The U.S. spends twice as much on health care per capita as any other developed nation, yet it does not cover everybody.

If we could eliminate profits made by investors who contribute nothing to health care, and lessen the huge overhead of our complex chaotic non-system, we then could spend the current trillion plus health care dollars to guarantee quality health care for everybody. We then could emphasize prevention, increase outreach, attend to the public health needs of our citizens, return to using our training for the benefit of the patient, abolish the burden of paper work and truly create the "best health care in the world."

A few years ago I asked Donna Shalala after a health care forum why her remarks didn't include mention of a single payer type health care system. She said such a system would not be feasible unless the doctors in this country would join in speaking out for it. And she added that that is not likely to happen. How about it? I entreat all health care workers, and especially doctors, to learn more. You can start by reading "Sweeping Health Care Reform Proposed by Nation's Top Physicians," which appears on the Physicians for a National Health Program website (www.pnhp.org). I challenge you to put your mouths where most of you claim your hearts are: in support of universal health care. Can we make Wisconsin one of the early states to reach the goal of equitable health care for all? Our medical students may lead the way.

Dr. Linda Fabry Farley is an emeritus assistant professor in the UW Medical School Department of Family Medicine. She is active in the Coalition for Wisconsin Health, and Physicians for a National Health Program, which works  to reform health care in the United States.