Universal Coverage Is Not Universal Access

My thanks to Bill Robinson, an agent in the Palm Springs area, for forwarding an article from LATimes.com entitled “Universal healthcare’s dirty little secrets.” Bill is a longtime Health Underwriters leader and a bona fide news hound.

This gem, posted on April 5th, is a column by Michael Tanner and Michael Cannon. Tanner is director of health and welfare studies and Cannon is director of health policy studies at the Cato Institute. It makes a few simple, but important, points for anyone engaged in the health care reform debate. Such as:

“… there’s a big difference between universal coverage and actual access to medical care. Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain’s Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that ‘access to a waiting list is not access to healthcare.'”

The same point was made by Dr. Brian Day. president elect of the Canadian Medical Association, when he spoke at a Los Angeles Association of Health Underwriters conference on March 28th (more on Dr. Day in a future post).

Tanner and Cannon go on to say, “Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.”

I don’t agree with everything in the article. For example, they write, “You may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. And yet, in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan’s Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a “causal relationship” between health insurance and better health. Believe it or not, there is “no evidence,” Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health.” I’m sure the study is legitimate, but personally I don’t buy the conclusion. That’s why I support health care reform, like CAHU’s Healthy Solutions plan, which seeks to make health insurance coverage available to all Californians. Still …

“Universal coverage” is the battle cry for many supporting single payer schemes like SB 840 (Keuhl). But there’s simply too much evidence that single payer systems fail in a crucial respect — they deny access to care. Single payer advocates who are more interested in sound public policy than catchy sound bites need to seriously address this issue.