Family Medicine Vital Signs

Universal health care works. That isn’t a radical or unsupported statement. Dozens of countries throughout the world have implemented systems to provide medical treatment to even the poorest of their citizens. In countries where universal health care exists, it is popular across the political spectrum. Consider this: the lie that British Conservatives told the United Kingdom to win the Brexit referendum in 2016 was that leaving the EU would provide millions of additional pounds for the British National Health Service, which is not just government-regulated insurance or even government administered insurance, but a full medical system run by the UK government. That’s not just socialized medicine, it’s the most socialized medicine—and the argument was appealing enough to British right-wing hardliners to swing the vote to leave.

In the United States we have been sold the lie that having a profit-seeking entity sitting between patients and providers is a better system, but even a cursory inspection of the idea shows how ludicrous it is. There is ample anecdotal evidence about the struggles that people have with their insurance companies. And, of course they do. Insurance companies are beholden to their shareholders to make a profit, which can only come from taking in more money in premiums than they give out in benefits. They are incentivized to do the exact opposite thing that we as a society need them to do. Whatever government inefficiency might take place in a single-payer system pales in comparison to the inefficiency of allowing a system that is designed to not give out as much money as they take in to be in charge of disbursing funds for healthcare expenses, to say nothing of the savings in advertising costs and executive bonuses that would not be necessary in a government-run system. Even in our present system, the overhead of private insurance companies is several times that of Medicare.

There is no serious argument about whether universal health care is better than private insurance. There may be ample disagreement about how to implement universal healthcare in the United States, but not about whether it would work once implemented. As physicians, for the sake of our patients, we must do what we can to move the political conversation towards how we will implement universal health care and away from whether we could or should.