Why Universal Healthcare?

In December 2012, the United Nations adopted what was termed a 'momentous' resolution on Universal Healthcare. Support came from across the globe, including the US, but the reality almost four years later still falls woefully short for many individuals and families. The idea that any family is one illness, one accident, away from bankruptcy is absolutely the antithesis of the Universal Healthcare concept, and deeply troubling from an ethical perspective.

 

Living in Canada, I have been the benefactor of a country wide, provincially directed healthcare system. I have been both a lifelong patient, and a nurse working within the system, and there is nothing so comforting as knowing that when I seek quality health care, that I can access it the same way anyone of lesser or greater financial means could.  My family is not in severe debt over health care bills compounding interest year upon year, I have excellent doctors, and I have the ability to seek second opinions or switch caregivers if I deem it necessary.

As a nurse, I don't have to count the number of supplies I use when caring for my clients. I do not have any indication in their records of their financial health, nor whether or not they carry additional coverage for prescriptions, dental and eye care. It means I can give the best care to my patients and not have to give a second thought to whether or not they can cover the cost of that care.  

A colleague of mine opted to practice in the US shortly after we both graduated from University in the late 1990s. She was courted by a US based medical staffing agency with promises of great hours, high pay, and housing allowances.  When she returned from the states, Texas to be specific, she seemed to be entirely disenchanted with Nursing. We spoke about what it was like to work in the states, at that point long before 'Obamacare' had been introduced.

My colleague, who I will refer to as Jane, was most upset by what she could not do for her patients as opposed to what she could.  Patients would arrive at hospital in a variety of ways, but before she even began her nursing assessments, Jane could see it clearly marked on the client charts whether or not they had any health insurance. The point was constantly driven home to her by her supervisors, if the patient had no coverage, they were to receive an absolute minimum of care and be discharged at the soonest possible moment. Conversely, if a patient was admitted who had full coverage and insurance, the staff was encouraged to run any and all diagnostic tests, to slow-track discharge, and to use a heavy hand with supplies and treatments, involving as many members of the Health Care Team.

Jane spoke of other issues, particularly those related to undocumented immigrants, frequently unaddressed language barriers, and the number of patients that arrived at acute care settings long after they should have, often delaying care until a situation was dire.  Once a serious condition or injury has progressed past a certain point, getting it managed and/or healed is often an entirely uphill battle. Contrast this situation to one where a small wound is cared for at a walk-in clinic or physician's office before it reaches the critical point where far more expensive and extensive interventions are required.

Is this story anecdotal and possibly out of date, absolutely. However, it has always remained with me for a very simple reason. I don't want to know my patient's financial circumstance, I don't want it to alter the excellent care I provide in any way, nor do I want to feel pressured to do more or less based on something so far removed from what I believe Nursing is meant to be. Jane almost left the Nursing profession entirely, and likely would have had she not returned to Canada and our taxpayer funded Universal Healthcare System.

Speaking purely as a patient, I wouldn't want to seek care had I no insurance and lived in the US. If I knew I could barely afford food and housing for my family, a strange lump in my breast tissue or persistent infection in my lungs might well be relegated to the bottom of my priorities list. This would be the case particularly if I knew it would bring not only a financial burden, but prevent me from working in a market where full-time employment is scarce. 

Is there any better argument for Universal Healthcare? It costs the system more, not less, to care for an advanced illness. It costs society more, not less, when a taxpaying fully employed citizen is struck down with a catastrophic illness as opposed to a small treatable condition.  It smacks of hypocrisy to suggest that all people can receive equal quality care in a pay-to-play system. It also highlights the growing inequity between those who can and cannot afford health insurance.  Obamacare, and indeed all government directed health programs are never perfect for everyone, but if they benefit the most people in the most humane and cost-effective way, we become healthier as nations and as a society. When you support Universal Healthcare you are saying that the health of your citizens is just as important, if not more important, than the wealth of your citizens. It is just one issue to be addressed on the Progressive dinner plate, but in my view, it is the one staple that all the others require to succeed.