Affordable Health Care and Health Disparities

Gerry Schroeter, moderator
Dr. Colin Moseley, presenter
USCB Hilton Head Island
                                                                                                                                                   

Dr. Moseley’s career prior to retirement included stints as chief surgeon at the Los Angeles Shriners Hospital for Children, clinical professor of orthopedics at UCLA and president of the Pediatric Orthopedic Association of North America.  

Noting that discussion of universal health care (UHC) does not lend itself to 15 second sound bites, Dr. Moseley used statistics, anecdotes and comparisons in graphics and slides to make the case for the United States to change its system. A graduate of McGill University in Montreal, he frequently used Canada as an example of a country whose health care system serves its citizens well.

The movement for UHC in Canada began in Saskatchewan in the 1960s. It met the resistance of hospitals, insurance companies, doctors, some patients and others, but over a period of two to three years all of the Canadian provinces opted into the new national system that emerged. Principles were that care should be universal, accessible, comprehensive, portable and publicly administered. Doctors could opt out entirely. Extra billing beyond what the government paid was prohibited. There was no private insurance.

“When I started my medical practice, I had to bill patients and set up a network for collections. Then the government started paying 100 percent of the bills, and I loved it, as did everybody else,” he said. Problems in the Canadian system are that mental health issues are not well covered, opioid addiction is not covered and there are wait times for major procedures such as joint replacement (overcome by early diagnosis and applications).

However, in his judgment the benefits of the Canadian system are:

1. All get medical care. In the United States, for example, a carpenter without good health insurance can receive emergency treatment for a damaged hand but may not be able to afford the surgery needed to restore full use of the hand. UHC would change that.
2. The public gains a level of financial security. In the United States, of the 400,000 personal bankruptcies annually, two-thirds are for medical costs. Organizations like Volunteers in Medicine are great but they do not handle everything.
 3. Costs are controlled. The United States spends 20 percent of the Gross Domestic Product on medical care, twice as much as other industrialized countries. Medical overhead expenses are 19 percent here, compared to overhead expenses of 5 percent in Canada.
4. Overall results are good. Compared to the rest of the industrialized world, the United States has a lower life expectancy and higher infant and maternal mortality.  “Everybody in this country says costs are too high and that’s why we can’t afford universal health care, but really this is the richest country in the world, and costs can be controlled,” he said. “The problem is that no one (not the hospitals or the doctors, the nurses, the pharmaceutical companies, the manufacturers nor the insurance companies) is motivated, and the patients are not organized.”  Government can control costs by controlling facilities, setting a funding package, negotiating prices (as for drugs) and negotiating fees (as for personnel), he added.

Objections in the United States to UHC include the notions that patients will show up unnecessarily for health care, that taxes will have to go up, that freedom will be reduced if government ran the system, that government will become too big and that UHC means “socialism.” The speaker countered those arguments by saying others experience less than 1 percent of patients seek care unnecessarily, that higher taxes would be offset by the lack of private expenses for care and insurance, that the big programs of Social Security and Medicare are run very well, and that the word “socialism” has been abused. Social programs go a long way explaining the very high happiness index in Europe and Canada, and the lack of social programs help explain the low happiness index in the United States, he said.

Addressing two other concerns, Dr. Moseley explained that the Canadian Medical Protective Association handles malpractice complaints and that Canada’s investment in medical research is an integral part of its safety net health care system.

Ethical questions around UHC are: Is each person supposed to take care of himself/herself? (Joe Manchin’s view). Or, is every person both obligated and entitled to participate in the social safety net? (Joe Biden’s view).

Audience participation:
Asked whether the increasing use of artificial intelligence and telemedicine will be good or bad for health care, the speaker said both have the potential to be advantageous to patients and to health care workers.

Issues raised by members of the audience mainly dealt with this question: “In light of this country’s political system, how do we get there?”

“Do you see things changing here?” one audience member asked.

Our sincere thanks to Dr. Colin Moseley for his outstanding, clearly stated and well-received presentation.  Thanks also to Betsy Doughtie and Joe Chapell for their Zoom and audio-visual expertise, and to Fran Bollin for her always excellent and concise note-taking and summary.