1991-1992 Harry Singer Foundation National Essay Contest
Conforming to Reform
by Irene Porter
As inflation continues to rise, the efforts presently being made to reform America's health care continue to fail. Cost control was recently compared to squeezing balloons, in the New England Journal of Medicine. "Squeeze the balloon in one place and it bulges somewhere else." An example is the decrease in drug use. Although the decrease was an overwhelming 35 percent, the amount of nursing home admissions doubled. By implementing cost control, the needy and uninsured are often left in the dark without medical care. These are the individuals who have the greatest need for such care. Hospitalization costs, malpractice, expensive surgical procedures, nursing home costs--all of these issues have been the objects of attempted reform through cost containment. Yet continually these efforts have failed, proving to be of no great long-term improvement. If all efforts to reform America's health care system have failed, then what is the answer to the problem? The answer lies not necessarily in reforming, but rather in conforming. For once America must adjust that it need help. The health care systems of Great Britain and the Netherlands prove to be most acceptable for implementation in the United States.
The National Health Service (NHS) of Great Britain is often referred to as the socialist approach to reform. In this system, every citizen's health care is provided for. Is not the right to an adequate quality of life one of our basic rights as Americans? Did we not come into society to have this right protected by the government? As things presently stand, this right is not being protected for all citizens. The poverty-stricken and uninsured cannot possibly afford health care at the present price. We are denying these citizens their right to life, protected by our Constitution. By implementing the NHS, this right would be protected for all individuals. For 40 years, the system has thrived with few problems. Priority care goes to life-threatening disease or chronic illness. The majority of coverage is received by the elderly and younger people. Non-life threatening illnesses and elective surgery are placed on a waiting list. This is a small price to pay for such a thorough health care system. The publicized problems of lack of medical staff and underfunding are not necessarily due to the NHS, but rather to the frugal spending of the new governmental authorities. This would have no effect in America if the government would be willing to pay the price for such a solution. This system has proven to be economical and effective for long-term reasons. It has functioned for 40 years with few complications. If the United States were to adopt the NHS, the adequate funding necessary would be well worth the American people's money.
The Netherlands health care system is similar to the NHS used in Great Britain. Here, the coverage is both socialist and private. The compulsory coverage of each individual varies with levels of income. Employed individuals with an income below a designated level, pay a premium to on of three insurance companies. The majority of the Dutch fall into this category. This system consists of the Sickness Fund Act, covering ordinary illness, and the Exceptional Medical Expenses Act, providing long-term care, services for the blind and deaf, as well as coverage of mental illness. The remaining 30 percent of citizens not covered by the compulsory system buy into private insurance companies. The 70 percent of citizens covered by the governmental health care system have the option to facilitate additional private insurance policies to improve the care already provided for. The Cross Societies, founded in the 19th Century, offer bedside care, immunizations, and prenatal education. In addition to these coverages, the expectant mother is guaranteed return employment. Healthful lunches are served in schools, and after-school programs look after the children of working parents. The cost of such a program would seem to be enormous, but in actuality, it is equal to the percentage of the Gross National Product set aside for health care in the United States. The ratio of physicians to hospital beds is also almost equal to that of the United States. Half of the burden is therefore solved and the government needs only to say the word to install such a program.
The time needed to install the NHS system, or that of the Dutch, is, as expected, quite extensive. Many changes would be needed and "necessary evile" would have to occur to reach the greater outcome that lies within our grasp. One of these changes would be the period of unemployment for those that work for the private insurance companies. This period would be temporary until the balance between private and governmental insurance agencies could be created. The reforms proposed can be seen as a utilitarian movement. The outcome will be best for the majority, if not all, American citizens.
By implementing one of the systems described, we will guarantee all citizens their rights to life and an adequate quality of life, provided for us by the Constitution of the United States. America must learn to be patient. The reforms we are presently attempting can be seen as quick fixups of "bandaids" covering up a powerful plague. The only antedote is a drastic adoption of foreign systems that have proven to be effective. We need only to say the word to begin the healing process of our health care system begging for treatment. The sooner we begin, the sooner we will heal ourselves and our nation.