My turn: Health care affects us all

Posted: Sunday, April 15, 2007

The numbers are telling. According to statistics from the Robert Wood Johnson Foundation and the Alliance for Health Care, of 285 million Americans, 48 million (16.8 percent) have no health insurance. Ten million (3.5 percent) buy private insurance apart from employers, the government or anybody else.

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Lest we get jittery about governmental intervention (also known as socialized or collectivized medicine), 74 million Americans (26 percent or one in four) have their health care provided by the federal government. This includes 5 million military veterans, 34 million Medicare beneficiaries and 37 million Medicaid beneficiaries.

The remaining 153 million (53.7 percent) are insured through employers (private, state and federal). Of working adults, at least 28 percent have no insurance within a given year. There are 16 million underinsured in our country. Sadly, of 9 million uninsured children, seven out of 10 are eligible for coverage but are not enrolled in a program.

What is wrong with this picture? A reasoned discourse about health care would suggest working definitions. Universal health care is the access to health care for all persons. Does this inevitably presume or mandate government ownership or intervention? The answer is no.

It is reasonable to ask just what constitutes our "universe" for universal health care in Alaska. This would include at least those who are employed with insurance, employed without insurance, the uninsured, the underinsured, children, Alaska Natives, Medicare, Medicaid, military, homeless, the unemployed and people in corrections. Our "universe" is all of us and each of us.

There are many questions for us to ask. For example, what components of health care do we want or need? Can each of us receive the same health benefits as our U.S. congressional delegation or our state legislators and elected officials? If so, how? If not, why not? How much medical care is equitable? Does health care include vision and dental care? What is preventive care, and how can we have some? How do our medical care systems in Alaska integrate with public health and "population medicine"? What are we really prepared to do for ourselves as we participate in our health care?

As if that were not enough of a challenge, how shall this be paid for?

Sixteen percent of our gross domestic product is used to pay for health care. Can our current patchwork payment for health care survive? Many think not. Our health care system is on a trajectory to implode with disastrous consequences for most of us.

What is a single-payer system and does this have to be governmentally owned? Are we destined to be shackled to employer-driven insurance coverage? Why? What about tax credits for health insurance? Is this a clearly understood concept for Americans?

Be not deceived. Your and my health care crises will not go away. The health care issue affects us all. If there ever was a time to participate in the discourse, it is now. If we do not ask the questions, we shall most assuredly not get the answers.

An adage that I have shared with patients over many years: "If you do not take care of yourself, it is highly unlikely that anybody else will do this for you."

Please stay involved in this one.

• Carolyn Brown is a doctor of obstetrics and gynecology, and preventive medicine. She is a Douglas resident.



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