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PDF versionOne system for all
Universal access to health care in practice
Feb. 03, 2010
Julie Castro speaks at a Karen refugee camp on the Thai border where she worked for a medical nongovermental organization.
Women: Birthing justice, birthing hope. Part 10 of 12
Julie Castro is a young doctor from France, a country that offers quality health care for all. All legal residents have access to coverage, and immigrants gain the right to access after three months (though spiraling xenophobia has created restrictions in practice). Those served by the medical system -- including the very poor and the gravely or chronically ill -- are likely to receive better care in France than anywhere in the world. Moreover, the sicker you are, the less you pay. Dire illnesses like tuberculosis or cancer, chronic conditions like diabetes, and major operations like open-heart surgery are covered by the state at 100 percent. France’s commitment is premised on the philosophy that the government has an obligation to the welfare of its people.
Julie Castro
Paris
My interest in health emerged as a way to take action in the fight for social justice. During my medical studies I did internships in Africa and India, and worked in a refugee camp located along the Thai-Burmese border. At the same time I became more aware of the anti-globalization movement, and it appeared to me that it was addressing the structural causes of ill health: inequality at both the global and local level. Today, while I’m working on the fight against AIDS in Mali, I’m also one of those defending the idea that access to public health in France is a right.
Even with its problems, the French health system is a good one. It’s a real distributive system. Universal access to health care is one basic value. A second benefit our system offers is equity in quality of care. In France, this means that the system should not make any distinction in terms of class, race or gender. It could be summarized as “one system for all.” Poor people don’t have to pay when they go see a doctor. Today, if you arrive in a bad state in a public hospital in France, you will be cured -- wherever you come from, whatever your language, documented or undocumented, all in the same way as a government minister would.
And another practical advantage today, I think, is the quality of care. Even if the infrastructure is overwhelmed and lacks people, the quality of public health care is still good.
The system is under great threat now. A very common sentence you can hear everywhere is “There’s a hole in social security” [the fund that pays for health care, retirement and other social benefits]. We have been raised with this idea, “Okay, the health system is too costly, money is lacking, we have to spend less.” Now in the hospitals, doctors are told not to prescribe too much of this or that, and all health workers are even trained not too use too much gauze -- because it’s all reimbursed by social security.
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Talking about a hole is a flawed statement. Long-term benefits -- like lives saved, illnesses prevented, and years of work spared -- aren’t included in this consideration. It’s really an ideological thing, a question of where we decide to put our money.
We already see how this is playing out in the U.S. The reputation American medicine has is that you can be dying in front of a health facility and they will ask you, “Do you have your insurance?” And if you don’t, you just die. This is very shocking to French people. The other thing we observe from this side of the ocean about American health care is the stigmatization of very poor people.
Cutting the budget so we move toward a U.S. model is only one answer possible to “filling in the hole.” The direction we should be taking is to improve prevention and start to truly tackle the basic determinants of health (the conditions in which people are born, live and work, which are determined by social factors such as income levels and power). This implies of course substantive shifts in many policy sectors: housing, labor market, education.
During the last months, hundreds of professors started to mobilize to preserve the human rights underlying our current system, because they feel the current reforms are threatening this ethic of care. Health professionals, patients and other sectors are also very engaged in the fight against privatizing health care -- more precisely, the fight against economic considerations trumping medical considerations.
The resistance is as strong as what is at stake: the world we want.
| About the "Women: Birthing justice, birthing hope" series
Among income inequality, seemingly endless wars, and debilitating climate change, it is difficult for many to imagine a path to a better way. In fact, throughout the industrialized North and the global South, solutions to these great challenges are in various stages of construction -- and much of the lifting is being done by women. Grass-roots women’s movements -- progressing often almost without money or access or institutional power -- are emerging and offering alternative and empowering visions. The above is part of a series, titled "Women: Birthing justice, birthing hope," which will appear in NCR by writer and organizer Beverly Bell, coordinator of Other Worlds. She features empowered women who offer alternative visions as they birth a new and more just world order. Seven of the articles in this series are available in a 2010 Lenten booklet, Cry Justice! Cry Hope! with additional reflections by Sister Joan Chittister. Click here to order. All the stories from the "Women: Birthing justice, birthing hope" series
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I believe we can thank many
I believe we can thank many in the Catholic Church for killing the health care bill in the United States. It was a good to defeat paying for abortions with tax dollars but there never was a proposal for "death boards or committees". The church will have to accept the respobility for many Americans not having health care because many of our leaders also lead the defeat of health care. In the mean time, many people on Medicare have lost coverage in benefits and drug coverage. Their increased medical costs will have to offset by any charitable contributions they make even their offerings to their churches.
Of course, you completely
Of course, you completely ignore the fact that if the bills had contained the restrictions against abortion (as in the Stupak amendment) and freedom of conscience clauses (as our President promised in his televised speeches), healthcare would have had the support of the Catholic Church and the bishops. But ties and pledges to those groups pushing for the expansion of abortion were too strong. So in the end, who bears responsibility for this failure?
i think it's great article
i think it's great article
The French pay a premium for
The French pay a premium for universal health insurance, in the form of:
* high personal income taxes
* something like a 19% unemployment rate, and persistent to boot
* free education through college, but those graduates are unemployed or under-employed. Once employed, employers have great difficulty firing anyone (thanks to French unions and labor law).
There is no incentive to for workers to better themselves and change jobs, and no incentive for employers to hire new graduates. There is no incentive for innovation, since it is subject to constraint by the State and veto by organized Labor.
The health care bill has been
The health care bill has been defeated by the American people, people who do not want government controlled health care. They do not want rationing of health care (which will inevitably be the result of the government setting prices, thereby reducing the amount of money that doctors and nurses can make, thereby reducing the number of doctors, nurses and other health care providers). They do not want bureaucrats telling them what procedures they can undergo and how long they have to wait before the procedure can be performed (as happens regularly in "health care paradises" like England and Canada).
If the issue is making certain that every American is covered by health insurance, then the government can do that by an expansion of Medicare/Medicaid, a law that forbids insurance companies from declining coverage based on pre-existing conditions (the only part of the bill with substantial public support), and allowing citizens to purchase health insurance across state lines (which will cause a dramatic upsurge in competition and cost reductions). There was no need for such a massive reform of a system that works pretty well for the majority of US citizens.
The health care bill was little more than a massive power grab by the US government...an attempt to enroll as many people as possible on the public dole so that people become dependent on the government. People who are dependent on the government are less inclined to criticize it and less inclined to protest as more and more freedoms are taken away.
As Ben Franklin famously quipped, "They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety". To paraphrase, we could say, "They who can give up essential liberty to obtain a little temporary health care coverage, deserve neither liberty nor health care coverage".
As Ben Franklin famously
As Ben Franklin famously quipped, "They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety".
Clint, if you're going to quote Ben Franklin do so appropriately. In the quote cited he was talking about war, not a health care system.
Further, the American people very much want a universal health care system but many are confused because of the propaganda financed by the insurance companies, the drug companies and the politicians in their pay.
I would much rather be under the power of the government than under the present dominance of the insurance companies; at least, I can vote if I don't
like what the government does; under the present system, I can do nothing.
The quote from Franklin may
The quote from Franklin may indeed have been particular to his circumstances, but is applicable in any and all situations wherein we find ourselves faced with the alternative of less freedom and greater safety, or vice versa.
I cannot comprehend how anyone would honestly turn over their health care decisions to the government; the same government that has nearly bankrupted social security and medicare, whose failed policies of encouraging people to buy homes that they cannot afford directly led to the housing/banking crisis of 2008/2009. In addition to the government's absolute inability to run any organization or program efficiently, there is the increasing danger of the government telling people what to eat and not to eat, what to drink and not to drink, when to exercise, how long to exercise, etc.; that the government will start initiating these regulations is clear -- after all it already regulates what kids can and cannot eat through schools and enforces all manner of nanny laws on us at the same time.
Once the government is paying all the bills, how long do you think it will be before the government is making decisions about the value of individual life? "Arlie over there is 73 years old and has serious illnesses, it is too expensive to continue his care. Let us allow him to 'die with dignity'". "Nancy is pregnant with a developmentally disabled child, one who will require constant health care from the moment of his birth until he finally dies. Nancy's pregnancy must be terminated". "Billy, I'm sorry but your cancer is too serious and expensive. I know you're only 12, but for the greater good, we cannot help you any longer. Here's some morphine, use it to kill the pain until you quietly slip away". That is the future we have to look forward to if we allow the government to make our decisions for us! God forbid!
Under the present system you have the choice of being insured or not. You have the choice of living your life in the manner in which you choose, and not having that life regulated by some bureaucrat somewhere. Under the single-payer plan, the "universal health care plan", we will not have that freedom. Under the single-payer government controlled health care system, even the right to life will be up for grabs.
If that's what you want, then fine. But don't force it on me, or on the millions of Americans who do not want this system and will fight it with every breath. If you want the government telling you what to do, what to eat, what to drink, when to get treatment, when to work out, when to die, then go ahead. But kindly have the decency to leave me and the rest of us alone.
Clint - what it God's name do
Clint - what it God's name do you think Medicare is but a government run health care program? What senior citizen has a "choice" about being insured? They are covered, period. They can buy supplemental insurance - but even they complain when costs escalate. I amazes me that senior citizens rail against government healthcare without even realizing that they are the beneficiaries of it. As for the government telling you what medical treatment it will pay for - what do you think the insurance companies are doing now?
The big difference between the current system and a universal system is that poor people under 65 can't afford coverage and are at great risk because they don;t get routine care. How is that just? If they do get very sick and go to a hospital with not insurance (at least in NJ) the hospital has to treat them. Who do you think pays those costs?
Finally, health care insurance is a huge burden on the economy but most people don't see it because their employers pay for it. As expenses increase, employers are cutting back on benefits and employees to cope. I predict that as employers increase employee contributions and even stop offering health care, there will be a groundswell for government action.
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