Heads up on health care

Imagine the United States as a person, always staring down at their feet instead of looking up. A little advice, U.S.: there's a big pulsing world out there, and sometimes, those other countries get things right.

I did some checking, trying to find a successful health care system somewhere in the world based primarily on privatization. I found nothing. Countries with the most coverage, lowest costs and highest patient satisfaction rely on nationalization.

England, for instance, is almost entirely nationalized, funding its health care system through taxes and government subsidies. The program also saves money through lower administration costs and lower salaries. A well-paid doctor in England will make about $100,000 to $150,000 a year compared to triple the income for the same doctor in America.

Imagine feeling a pain in your stomach or suffering a sports injury without the always-agonizing internal argument: "Can I afford to go to the doctor?" In England, France, Germany, Taiwan and many other industrialized countries, this question never pops up.

Though the national systems above are good, they are not perfect. As Brinley Bruton writes in a recent MSNBC article, some of the care in British hospitals

is lacking because hospitals are understaffed and overpopulated. But in the end, Bruton's needs were taken care of; attendance outweighs convenience.

If you want luxury, pampering from doctors and nurses, you're going to have to pay for it. But something you'll never ever have to deal with in any of the countries mentioned is bankruptcy due to medical costs. If you stopped a person on the street in London or Paris and talked with them about medicallyinduced bankruptcy, they'd laugh or stare at you as if you were a nut.

According to a 2005 Washington Post article, "every 30 seconds in the United States, someone files for bankruptcy in the aftermath of a serious health problem."

Medical bankruptcy for Americans is absolutely possible, while to the French and British and many other nations it is absolutely absurd. To offer some perspective, a year ago in France there was a public outcry over the notion of adding a non-reimbursable .5 Euro (approximately $1 U.S.) fee to drug packets and non-traditional forms of therapy. One dollar? We would love this kind of problem.

Barack Obama proposes a nationalized system that would coexist with the private market to cover the large number of Americans unable to afford health care. Over time, if this national plan is successful, the majority of Americans would probably climb aboard the socialized health care train, while those able to pay for "luxury" health care (no waiting lists and ample pampering) would still make use of the private systems, as is the case in countries like England and Germany.

While Obama looks up occasionally from his feet, John McCain and his party don't seem able to move their necks.

McCain focuses on improving American health care through private competition. As it stands, employers who provide health care must pay all of the taxes on these policies. McCain wants to shift that tax to the employees. Sound good? He hopes to offset this move by providing a tax credit ($2,500 for individuals and $5,000 for families). With this tax credit, employees will be able to pay off the new taxes and Americans who aren't covered by employers can use the credit to purchase a plan on the free market.

But many experts, including University of North Carolina associate professor of political science Jonathan Oberlander, whose primary interest is health politics and policy, don't believe the tax credits will outweigh the new taxes.

There are complications inherent in both privatized and socialized medicine, but one constant in private health care that disappears in a nationalized system is underwriting. Underwriting is a euphemism for greed: large corporations (banks, insurers) assessing the eligibility (and usually denying the wishes) of prospective costly clients.

Do you know someone who was turned down for the coverage of insurance or medical procedures because of pre-existing conditions? Do you know someone who had a nervous breakdown through fighting insurance companies for reimbursement? Underwriting is the root problem, and basically underwriting stems from profit, the need to make more money. If you want to create a system that services everyone fairly, profit cannot be a factor, and in my opinion this is the most pressing impediment that stands in our way.

Both the Obama and McCain plans contain many questions and are quite vague, and though I'd choose Obama's plan over McCain's in a heartbeat, if I really had a choice I'd take a page from Taiwan, which recently formed a new system by sending out experts to choose from the best parts of successful health care systems around the world.

The United States, however, apparently lacks the humility to copy Taiwan's strategy, and in the meantime, we can only, as is always the case, choose the lesser of two evils.