As America’s eyes remain transfixed on the economy at home and the war on terror abroad, the plight of our nation’s health care is being ignored. Medicare and Medicaid, the already-troubled social welfare programs that subsidize health care for the elderly and the poor, do not reimburse doctors enough to entice many of them into accepting new patients. The American Academy of Family Physicians estimates that at least one in six physicians turns Medicare patients away, a problem exacerbated by a 5.4 percent decrease in Medicare payments to doctors this year. It is tragic that the health and well- being of the citizens of the richest nation in the world are jeopardized because Medicare and Medicaid are woefully under-funded while an unresponsive government refuses to act. Rather than providing inadequate health insurance for some, the government should offer quality health insurance to every American citizen.

This necessary step has long been postponed by conservatives who fear that the lucky Americans who can afford health care will lose the ability to choose their own doctor and level of coverage. But what kind of choice does the average American have now? Over the past 10 years, the rise of HMOs and other health care providers has taken the decision-making ability out of the hands of doctors and given it to bureaucrats. The bottom line compels many health care companies to raise patient costs while scaling back benefits. These companies have little incentive to invest in the quality of care and every incentive to deliver profits to their investors. Those who remain enamored of the current system speak of patients’ choice, yet health plans typically limit which doctors or hospitals a patient can visit. A free market for health care has unequivocally failed to provide adequate health care to all but the richest Americans, yet conservatives continue to place their trust in this flawed system instead of exploring more enlightened alternatives.

The phenomenal problems affecting those within this system don’t even apply to the estimated 38.5 million Americans who remain uninsured or the millions of others who still scrape by on insufficient government aid. Extending basic health care to these citizens is a critical national priority. The federal government should guarantee a minimum standard of coverage to every American via social insurance—allowing doctors and hospitals to remain private.

The government is ultimately accountable to the people, not to a collection of self-interested shareholders. Government money will go directly towards providing quality care to patients, not to handing out dividends. Under such a system, doctors should be paid high salaries for the essential service they perform; this would prevent “brain drain” from the medical profession and avoid the delays in elective procedures that have become problematic in other countries. Furthermore, such a plan would not preclude a private health insurance industry for patients who wish to extend their health care benefits to cover experimental drugs and procedures, nor would this system prevent Americans from buying additional health care completely out of pocket.

It is clear that this program would cost a significant amount of money, but aside from the myriad moral reasons for such a vast expenditure, the intangible benefit of having a healthier, and therefore more productive, workforce is paramount. Critics of such a plan should consider the increased productivity and other obvious benefits that would result from Americans living healthier lives. And the federal government already spends huge amounts of tax revenue to provide health care to Americans through tax subsidies and programs such as Medicare, Medicaid and workers’ compensation. A vast amount of money would be saved with a much more efficient, centralized government administration. Opponents of “big government” should recognize that Medicare’s administrative costs are 7 to 28 percent lower than private industry costs, according to the Physicians for a National Health Program.

As recent history shows, health care and shareholder interests are a terrible combination. It is time that basic health care be considered a right, not a privilege, in America. Where corporations have failed, the federal government must step in.

Dissent: Bureaucratic Disincentives

Socialized health care has gutted the quality of care in countries that have tried it, such as England and Canada, and it would do the same in America.

In Canada, the government bureaucracy decides who will get what procedure and when. Regulatory prohibitions make health care “equal,” but in so doing destroy the profit motives that made quality care available in the first place. Orange County, Calif. does not have more MRI machines than the entire country of Canada because the citizens of Orange County care more about health than Canadians do. Orange County has more MRI machines because doctors benefit financially from operating them.

What is true of medical devices is also true of medical practitioners. The quantity of medical school applicants has dropped off in recent years, probably because of the poor image of HMOs. A drop in quality will not be long in coming. Should the government lower doctors’ revenues by further intruding into medicine, potential doctors will instead choose to be scientists, lawyers or management consultants; the price of quality health care will be driven ever higher.

The Staff believes that increased government involvement will not lead to more paperwork but less. There are many things that government has the ability to do; introducing efficiency is, historically, not one of them.

One reasonable way to better American health care is to improve access to preventative care. Such care would keep people healthier to begin with and would be cost-effective. Why create a massive bureaucracy when we can preclude problems by subsidizing preventative care? Instead, the government should provide a check-up voucher to poor American families.

American health care is an extraordinarily complex problem. A government-size-fits-all system is not the solution.

—Zachary K. Goldman ’05, Paul C. Schultz ’03

and Andrew P. Winerman ’04