Bruce Goderez: The case for universal care

Last modified: Tuesday, January 07, 2014
Dr. Jay Fleitman has written several spirited criticisms of the Affordable Care Act (ACA, or Obamacare). I am also a physician in private practice in our community, and would like to present an opposing view.

Fleitman’s first beef is about the currently uninsured, noting that 80 percent of the early sign-ups for Obamacare were for Medicaid, paid for entirely out of tax dollars. He asks rhetorically where all that money is going to come from, and goes on to complain about arrogant liberals conspiring to force their misguided agenda on “Americans who will be forced to buy mandated services they don’t want or need.” These early signers, some of the 40 million uninsured Americans, evidently want and need what Obamacare has to offer. Fleitman seems to take it as a given that the nation can’t afford to insure all these people, and therefore they will just have to go on suffering and dying for lack of basic medical care. If it were true that we can’t afford it, then his position might be defensible at least from a hard-nosed economic point of view, though many of us might find it callous. However, it is easy to demonstrate that he is wrong, and that we can afford to provide universal health care.

When asked about the morality of leaving people without coverage in this richest nation on earth, presidential candidate Mitt Romney responded (somewhat plaintively, I thought), that when people are sick they can always go to an emergency room. Emergency rooms are required by law to accept everyone regardless of ability to pay, precisely because we as a nation have decided that it is not acceptable to let people die on the streets for lack of care. However, emergency room care is unbelievably expensive, and does a terrible job of caring for people with chronic illnesses. We are currently paying for all this expensive substandard care through taxes and inflated insurance premiums.

The United States spends twice as much per person for health care as the average spent by the major industrialized countries, yet we rank 46th out of 48 developed countries for health care efficiency. Furthermore, we have one of the shortest average life spans.

Using emergency rooms to provide primary care is just one small example of the insane practices that result in our system delivering poor medical care for twice the cost of superior care in other countries. Universal insurance will ultimately help us to provide appropriate care in appropriate settings, with far better medical outcomes and at a fraction of the cost of what we are doing now. The answer to Fleitman’s rhetorical question, therefore, is that the money will come from designing ways to spend our health care dollars intelligently, instead of stupidly.

Fleitman criticizes the ACA for establishing standards for medical insurance and mandating that substandard insurance must be eliminated. He asserts that the American consumer should be allowed to decide “what standards they accept when buying insurance for themselves and their families,” and complains that liberals are arrogantly forcing their ideas of appropriate care on proud, free, independent Americans.

Allow me to ask some rhetorical questions: Are the millions of uninsured “deciding” to accept being uninsured? Are the millions of under-insured “deciding” to accept lousy or even fake insurance, and the constant threat of bankruptcy if anyone gets ill? In today’s America you are indeed fortunate if you have any real choice as to what insurance you will accept, and it probably means you are financially in the top 10 percent of the population. Obamacare is attempting to give people more options, with better insurance for less cost. What exactly are the conservatives objecting to?

The ACA is a complicated law because it is trying to repair an incredibly complicated system. The current problems with implementation are already improving, and will eventually be resolved. There will be numerous problems in the next few years, which will require adjustments and amendments to the law. The fact that the new law was not born in perfect working order has nothing to do with the merits of what it is trying to achieve.

Our current dysfunctional medical system is responsible for causing human tragedy on a vast scale. It is also bankrupting the country, and is a major factor in the downward mobility of most of our population. I have tried to demonstrate that conservative criticisms of Obamacare amount to slogans without much substance. A true conservative, you would think, would be in favor of fixing a system that is destroying our nation. Instead of trying to sabotage the ACA, our conservative friends would do better to roll up their sleeves and make some constructive suggestions.

Dr. Bruce Goderez is a psychiatrist in private practice in Hadley who works with nutrition, hormones, etc, as well as conventional medications.