Health Care: U.S. vs The World (PBS) documentary provides comparisons of universal healthcare models from other countries including Sweden, United Kingdom, Australia, and Canada. Often, the U.S. is compared to Canada when describing the benefits of universal healthcare and many like myself were not aware of other countries with similar models. Universal healthcare for those who do not know the intricacies can be misconstrued that everyone has equal and available care. This documentary exposes not only the “perks” of such a model but also the persistent marginalization of at-risk populations such as low income, homeless, and those with mental illness. The continued marginalization of these groups is a common theme no matter the country or model. Private insurance plans exacerbate this marginalization by allowing the privileged to access care quicker almost like “skipping the line” to clinics, private rooms which may impact space for additional patients, and fancier meal choices are more costly and take funding away for more “regular” meals for the “publicly” insured. It is essentially creating again the hierarchy based on income and wealth within the health system.
Hearing from citizens of the U.K. who are waitlisted for elective surgeries as the care is essentially rationed to the sickest patients brings another aspect to the discussion. Do Universal Care plans also include mandates on primary prevention for citizens? Are citizens required to attend to annual physical exams, encouraged to maintain healthy waits, avoid risk behaviors like smoking or excessive alcohol? If I were a U.K. citizen working as a healthcare provider as I do in the U.S., I would have a difficult time with a patient moving up the waitlist for intensive care management of alcohol cirrhosis patient who continues to abuse alcohol compared to the patient who needs a knee replacement and cannot return work as a plumber until it can be done. I recognize this brings up the true rationing of care which can be a scary concept for sure. It is often what I think of when we look at universal care in the U.S. I understand the situation I described but recognize many scenarios can come up much like if watching a medical drama. The U.S. Citizens likely would raise this concern of “I pay into the system just like this other person does so we should get the same level of care”. As a healthcare provider, it is hard some days to continue to manage patients who do not engage in self-care, avoid risk activities, and really expect their doctor to fix their issues with a pill. This in my mind is part of the failure and overall expense of the health system. I would advocate that some sort of responsibility should be placed on the citizen. For example, considering reduction in cost of health care policy if you are a non-smoker much like life insurance policies are managed.
This documentary really shared many aspects, the good, the bad, the ugly of universal healthcare. It brings about aspects that many of us may not have thought about. Subsidizing healthcare is great but only if it continues to be affordable for much of the population. Raising the income levels for subsidies is key to ensure that all people have ability to access health coverage, healthcare, which in turn can improve overall health of the communities and improve economic burden. As always, there is always more to the story, and it is much more clear after this documentary experience.
Hi Kara,
I really enjoyed your review of the film and the reality of how much a burden health care can be. I am new in my Health Care journey so watching this film was just a glimpse of what I hope to learn. I see in all the countries that they are doing their best to balance services. Unfortunately, I cannot wrap my mind around the intricacy and the work that the U.S. needs to do to get better care to everyone. I was also struck by the patients in the UK with a year+ wait time on knee surgery and how private insurance is getting those who pay better care and more options. I would have valued it if the documentary at least contrasted some of the financial realities. I was getting the emotional and political cost but what is the breakdown? Why does the U.S. spend 3-4 times more on services, how much of that plays into innovative technology and pharmaceutical, and who is deciding on these prices. I often think out insulin and how exploited that has been in the market and I cannot help but wonder how the lack of control for medicines plays into the over burden of health care in the U.S.
I am a person studying Health who avoids going to the doctor because I cannot pay for all of it. I like how you highlight the relief that some people feel in other countries that they just do not have to worry about it. I just wonder while we are working in the field and learning how can we create change in our U.S. system and how long would implementation take to show a real impact?
Nina
Hi Nina –
I agree completely that there seems to be lack of control of competition in the medication space. As a provider, we struggle daily on managing medical issues for patients due to the constraints that insurance policies place on us. However, I recognize that the insurance companies are trying to institute some sort of level of control by limiting what medications we can use to keep costs low. There certainly are providers who are not as cost conscious and/or may not follow evidenced based recommendations for treatment recommendations. I have seen patients who have had the “million dollar” work up when they really only needed just the CT scan for diagnosis. It is a tough balance and there is a need for some checks and balances. The checks of prior authorization for studies is very annoying at times, but I try to remember the process is justified in some cases.