In March of 2008, a survey of U.S. Physicians in the Annals of Internal Medicine revealed that a majority of Doctors favored Universal Healthcare.  We are told that there is a 'crisis' of healthcare in this country.  There are supposedly 40 million uninsured people, but many of them are healthy people who only need insurance for a catastrophe, or choose not to pay for insurance.  These people roll the dice and hope nothing bad happens.  They do the same thing with life insurance, dental insurance, and when allowed by law, car insurance (sometimes even when not allowed by law). 

Somehow, having health insurance became a 'need' that evidently most people see now as a 'right.'  Hmmm.  That right doesn't seem to be included in my copy of the Constitution.  Why don't we have a 'right' to good food, or a nice car, or a nice house?

Here is my completely unbiased analysis on the pros and cons of implementing universal healthcare.

Pros:

• We all have a right to free healthcare. And Hillary says we need deserve it.

Cons:

• We already cover those not insured.

People must think that if you do not have health insurance, you will be left to bleed to death on the steps of the hospital.  While it is true you might be expected to eventually pay for services you receive (gasp, what a shock), no one is ever denied treatment because of their lack of insurance or ability to pay. 

I work as an Emergency Physician, and I know first-hand how people with no insurance are treated.  I have never sent someone home who needed a procedure or denied care to anyone based on ability to pay.  In fact, it might come as a shock to most people but the government ALREADY mandated that Emergency Care could not be denied to anyone based on ability to pay.  When a medical procedure or some other care is medically necessary, it is either given on the spot or the patient stabilized and sent to a government funded facility meant for those who cannot pay. 

There is no crisis of sick people not being cared for.  The only 'crisis' is that some of those people might be expected to pay for their surgery or whatever eventually.  Of course, they might be expected to prepay for some cosmetic or other procedure that is not immediately medically necessary.  What?  No free liposuction?

• The coverage will be politically based.

Special interests like Chiropractors have greased the palms of the politicians.  While their treatments are pretty much equivalent to that of a witch doctor, their lobby will make sure it is covered in the healthcare plan.  But since there is not much of a lobby for, say, smoking cessation programs or nutritionists or anything that might actually help people get better, those probably wont be covered.

• Everyone will be forced to have it.

The only way that 'universal coverage' will work is if it is truly universal; in other words everyone would be compelled to have it.  It is possible that the benevolent government would allow us to have private insurance if we could afford it, but that wouldn't be 'fair' to the less fortunate.  They might even make it illegal to pay cash for services as they do in some countries with socialized medicine. 

The problem is that the government sets the rates for reimbursement from Medicare now, and private insurance follows those rates.  The costs are going to be wildly beyond the predictions; they always are. 

Some try to say that Universal Care will actually save money.  Another layer of bureaucracy is bound to cut costs.  Thats what every company needs; more middle management to make things more streamlined.  The feds will eventually have to cut reimbursement to the bone, or come up with a ton of money, or both.  That money will have to come from somewhere.  Gee, where will the Federal Government get more money from?  I wonder.

• Bend over taxpayers.

You think your takes are high now?  Healthcare consumed 15% of the US gross domestic product in 2005.  That is almost 1/6 of the entire economy.  The government pays less than 1/2 of that now, and the rest is paid by consumers and private insurance.  If only we had a source of more money.

• The Government does what well?

Do you really want the same government that brought you the compassion of the Internal Revenue Service, the expediency of the Department of Motor Vehicles, and the thrift of the Department of Defense to handle your healthcare?  How about the solvency of Social Security, or the unbridled success of the Department of Education?  Can anyone name one thing the government can do better than the private sector? (Except perhaps the military; they kick ass.)

• Responsible people will pay for the rest.

Healthy people who make good lifestyle choices will have to pay to support others who decide to smoke, be obese, be non-compliant with their preventative care, or take unnecessary risks; and no, this is not a self portrait.  So a few people will be heavily taxed to support a larger number who would benefit.  Who would support a system like that?  Oh, wait.

• Let's all go to the Doctor!

When people don't have any responsibility to pay for something, at least not directly, they treat it like anything that is free.  Right now, anyone who does not pay any co-pay or out of pocket expense comes to the ER for the most frivolous things.  Feel a little achy?  Got a splinter?  Don't take a tylenol; just go to the ER! There aren't many people who can do this, but as one might imagine there would be a flood of people who would do this if they could.

• Oh Canada, where will you go now?

We are supposed to want to emulate the Canadian system of universal coverage.  An article in the Canadian Medical Association Journal stated "one could conclude that if a patient is over 65 years of age and has blood or protein in the urine, he or she could obtain extra medical insurance and head south of the border to escape the lack of facilities in Canada."  Where are we supposed to go when rationing and government controls give us no other options? 

People are not fleeing the U.S. to see Canadian doctors.  Some people go to Canada to buy medications, only because they are subsidized by the Canadian Government.  That money is essentially being stolen from the Canadian taxpayer.  I expect this will stop pretty soon.  Anyone interested in investing in a cash-only offshore clinic?

• Pay no attention to the man behind the curtain.

There will be regulations and lack of flexibility with patient care like we have never seen before.  I would much rather prefer that my health care is directed by someone like, say, MY DOCTOR, than a bureaucrat sitting at a desk.  When my nurse recently called an insurance representative (who was supposedly also a nurse) to approve how long a patient could stay for Congestive Heart Failure who was on IV Lasix, the insurance person asked how to spell 'Lasix'.  This was the person who determined how long you would stay in the hospital. 

The physician should ultimately decide the treatment course and when someone is to be discharged based on their medical need.  Do you think when the government controls healthcare, that will still be the case?  Almost without exception, when the feds pay for something, they tell you exactly how and when it is used.  Don't worry, I am sure they will change that policy when it comes to healthcare.

• The end of R&D

Incentives from profit motive and competition will disappear, and subsequently new technology, drugs, and therapies will come to a screeching halt.  If a company does not think it can make a profit or at least break even on something, why pursue the new product?  Not too many companies operate at a loss for too long.  Except the Federal Government.

• 99 percent of lawyers give the rest a bad name.

The trial lawyers own the politicians.  The shortage of medical care will cause the feds to implement rationing.  There will be ridiculous delays in diagnosis and treatment, just like there is everywhere that socialized medicine has been tried.  Patients will die, and there will be NO protection for the Doctors. The VA and Military Doctors have immunity from liability except in gross negligence.  We doctors will have all the benefits of our decisions being controlled with none of the protection.  Couldn't get a CT for two months?  Now the brain cancer is inoperable?  See you in court, Doc.

Here are a few good articles on the healthcare debate:
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

http://www.balancedpolitics.org/universal_health_care.htm