University Times

Will the United States provide universal health care in the foreseeable future?

A panel of local experts tackled that question following an Oct. 19 lecture on “The Fight for Universal Health Coverage in America.” Panelists included Steven Larchuk, a Pittsburgh attorney who chairs the Pennsylvania Healthcare Solutions Coalition and is principal author of the Balanced and Comprehensive Health Reform Act currently being considered by the Pennsylvania legislature; Valire Carr Copeland, associate professor in Pitt’s School of Social Work and Graduate School of Public Health; Andrea Fox, associate professor in Pitt’s School of Medicine and medical director of the Squirrel Hill Community Health Center, and Beaufort B. Longest Jr., professor of health policy and management and director of Pitt’s Health Policy Institute in the Graduate School of Public Health.

Larchuk

“I’m the raging optimist in the bunch, because I do believe we can achieve universal coverage in our lifetime,” said Larchuk, whose health reform bill (SB1085/HB2722) would mandate it in Pennsylvania.

Larchuk pointed to six components of the problem: Five of those components are relatively easy to fix, he said. But the sixth is nearly impossible to fix.

“We have to create financial efficiency,” Larchuk said. “Depending on which study you look at, 20-25 percent of the $3 trillion annual health care costs is wasted. That’s up to $500 billion — equal to the defense budget — going up in smoke.”

Other issues include ending the malpractice insurance crisis by creating a no-fault system that would provide a reasonable set of benefits to anyone injured by their medical care. “Doctors have had to practice defensive medicine and that’s not right. If we had a no-fault system, victims wouldn’t need to hire lawyers and there wouldn’t be long delays for getting settlements,” Larchuk maintained.

Further, there is a need to reduce the number of medical errors through a program that investigates errors and enforces better practices, he said.

“We also need to develop a culture of wellness,” Larchuk said. “Continuing to develop new treatments is one way to cut down costs, but an even better way is to shrink the need for health care.” He recommended adjusting school curricula to teach health and wellness throughout elementary and secondary school.

“And we need a dedicated health care funding model,” through payroll or other taxes, Larchuk said.

The one part that is nearly impossible to change via legislation is end-of-life care, “because that is a personal choice,” he said. “You have to answer that question yourself.”

But costs associated with end-of-life care are disproportionate in the health care system. “Life is precious, but is it priceless? Is surviving the same as living? These are questions that we must face, and I don’t have any simple answer,” he said.

“The president thinks health care is a state problem; the governors think it’s a federal problem,” Larchuk said. “But as citizens we can’t wait around for solutions. I think this needs to be jump-started at the state level. We need to break the ice, and maybe others will follow. If the Balanced and Comprehensive Health Reform Act, which will be re-introduced in January, passes, we’ll be the first state to have guaranteed universal coverage.”

Copeland

“I would like to talk about the need for health care insurance, especially for children and especially for poor children. Health care is a lifespan issue, and the lack of health insurance has a negative impact on well-being throughout a lifetime,” Copeland said.

“If you look at children from a poor family, their health care is poor, and the consequences include that it’s harder for economic success in adulthood.”

As the income gap in health care coverage increases, so does the success gap — in education, employment and well-being, she said.

Many acute illnesses in childhood increase the risks for illness in adulthood. This also affects poor children disproportionately.

“Poor health care for children is only one factor determining success, but there is a big link there,” she said.

Fox

“I’m just a lonely doctor inside a system that’s a big mess,” Fox said. “I believe there should be universal health care, but I struggle with what we have now being extended to everybody.”

Fox added two components to Larchuk’s list of health care issues: First, there needs to be more health care resources available for disenfranchised populations such as immigrants, Native Americans, veterans, prisoners and the elderly.

The second is that medical school tuition is too expensive, she said, forcing doctors who are in debt to seek avenues other than treating patients to compensate.

“We have records systems that are geared to billing, not achieving health. I spend so much of my time checking boxes instead of treating patients. We have health care that doesn’t really equate with health. It’s like health is an accidental byproduct.”

One bright spot is the Veterans Administration health system, Fox said. “Their programs are complete, they have social services, for example, and they’re patient-focused, so we have a model of care to turn to.”

However, Fox is pessimistic about universal health care coming in the near future. “I’m a medical nihilist. We’re so ambivalent in this country. We believe no one should get something for nothing. We have older adults who have insurance but are getting terrible care. You can get dialysis essentially forever, but your time to have home care is limited.”

Longest

“When we talk about the number of uninsured in this country, whether you say 46.6 million or 85 million, we need to remember that it is a number that we built,” Longest said. In the 1930s with the advent of Social Security, “it was a system for people who had a job. So the government said, ‘Great, excellent idea, it won’t cost us anything, except maybe a little tax relief.’”

Then with the introduction of Medicare and Medicaid in 1965 the government became a major funder of health care and the number of uninsured was reduced, but only piecemeal, he said. “If we track the population, the ratios of uninsured to insured haven’t changed much. It’s a larger number of uninsured but not necessarily a larger proportion.”

Although the proportions have been relatively stable, the perception is that the scope of the problem has increased, Longest maintained. “More people think health care is important to their lives and to their children’s lives. More seem touched by it. More people are caring about others.”

A recent poll ranked health care reform as the No. 2 problem in the United States. “The war in Iraq has jumped ahead of health care,” he said. “I’m concerned if health care is falling on the national agenda, because it takes government more time to address problems lower on the agenda. Inattention can lead to problems.

“But with more attention being paid, and as the problem is seen as really big, it may help get the focus on solving the problem.”

—Peter Hart