Last week I introduced the important essay published in The New England Journal of Medicine, "Do We Really Want Broad Access to Health Care?" (352:12, pp. 1260-1263, March 24, 2005).
James J. Morgan, M.D. and Thomas H. Lee, M.D. present an extremely thoughtful challenge to the physician community, as well as to public policy makers and all of us who elect them.
One of the more surprising and useful dimensions of their argument has to do with the essential importance of our regaining a genuine sense of inter-connectedness, of community as a people. In the view of the good doctors, we Americans have lost that over the past 30 years or so.
Community has been replaced with an almost undying commitment to "rugged individualism." Morgan and Lee wonder out loud about when this macho vision of American civic life turns to self-centeredness and then to downright selfishness. Somewhere along the way every serious effort at health care reform (1974--Nixon; 1979--Carter; 1994--Clinton) died.
The doctors are not naive about costs. Costs for real reform will be on the order of another Iraqi war. In addition, some Americans will gain and some will lose, as compared to what they currently have in health care benefits.
"If broad access to health care is ever to be more than a campaign sound bite, it cannot be a casual commitment. Americans must understand that they are going to make real sacrifices for other Americans."
Now, there is a novel idea--sacrifice for the good of the whole!
At the same time, there would be significant return on the investment of providing health care for everyone (somewhere between $65 and $130 billion annually!). Informed estimates indicate that over $45 billion could be saved annually on administrative costs alone if the right system were in place nationally.
Without action the number of uninsured Americans will only continue to rise, while the doorway to care for the uninsured will continue to grow more narrow and restrictive.
So, what is the bottom line?
Simply put: new tax policy.
"We believe that a fundamental and defining question for all health care providers who support broad access to health care is this: Are you willing to advocate publicly for higher taxes? If enough of us state the simple truth that this is necessary, we may create a political environment in which our leaders may eventually be able to lead on this issue."
I hope you will find your voice in this important national conversation. It is literally a matter of life and death for millions. What we have here is a moral issue transcending politics.
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