In all the discussion, debate and hyperbole surrounding the Affordable Care Act (aka Obamacare) and its efforts by reactionary forces in the US Congress to dismantle and/or replace it, there seems to be one issue left out that, I believe, is the core issue in the entire conversation over healthcare in America: is healthcare a right or a privilege? For all its efforts to expand insurance coverage for Americans, the ACA failed to shift the conversation towards one of universal healthcare coverage. The act worked to increase the number of Americans insured (whether privately or publicly) to lessen the financial burden placed upon families by healthcare expenses. This was a noble and much needed step for the nation, but its rationale remained grounded upon the assumption that healthcare is something of a privilege. Insurance covering physicals, prescription medications and well-child visits are wonderful, but what happens when the insured face something more serious than an annual checkup but serious enough to be considered catastrophic? The continued existence of steep deductibles and restrictive in/out of network plans make some healthcare choices easier, but still are a long way from removing the concern of untenable medical expenses. It also, I feel, gave far too much liberty to individual states. This resulted in a messy hodgepodge of marketplaces, expanded Medicaid states and unexpanded Medicaid states. In some areas there were many carriers and available plans for the uninsured to compare and select from. In other states the ROI did not work in favor of the insurance companies, and so only a single carrier participated in the marketplace (such was the case in North Carolina where we started out with three and currently only have Blue Cross/Blue Shield of North Carolina). This largely defeats the purpose of the marketplaces, a venue that was supposed to provide the uninsured an opportunity to shop for affordable plans for their needs. What has also happened is that we have seen a rash of proposed mergers in the health insurance industry; the claim, of course, is that ACA related expenses have driven up the cost of doing business and consolidation is the best response. Fortunately, regulators have so far blocked these efforts, but there is no doubt in my mind that these propositions will reemerge in the near future.

Still, in all this noise and bluster, we have avoided the key question: is healthcare in the United States of America a right or privilege? I am not talking about purely cosmetic procedures being covered by the American taxpayer. I am not talking about inserting government officials between provider and patient (any more than they already are). What I am talking about developing a system whereby any American can walk into any hospital, receive appropriate and professional care and be discharged without fear of crushing debt or unreliable health insurance. I am talking about Americans being able to take their prescription to any pharmacy in the nation and know that they will be able to obtain the medication they require without having to worry about whether the pharmacy is contracted with their insurance or if it’s a preferred or nonpreferred provider. What I am talking about is creating a healthcare system based upon research, evidence and effectiveness, not corporate profiteering, marketing and what’s going to create the best “customer service experience”.

Many , perhaps most, Americans would likely be in favor of such a system. However, describe this as socialized healthcare and their opinion immediately changes. Americans have been so poisoned against anything associated with socialism that they blindly embrace the very systems that have led to the current healthcare crisis. I would argue that much of the concerns and issues we face in the American healthcare regime stem directly from our longstanding fear of change and thoughtless support of a system that privileges all the wrong things. We need doctors who can tell a parent that their child is likely experiencing a viral infection and that no prescription antibiotic will solve the problem. We need pharmacists who are more than just cogs in a retail machine, pumping out tablets and injections regardless of whether they are genuinely in the patient’s best interest. We need hospitals that focus less on how much technology they have and more on how they are helping patients take responsibility for their own health. We need pharmaceutical companies that are looking at truly revolutionary therapies and not novel combinations of drugs to add to their patent portfolio or niche products designed to simply drive revenue from easily influenced providers and patients. Lastly, we need to remove from the triad of care the insurance companies that apply seemingly arbitrary and always opaque rules to the medications, procedures and services accessible to their clients. Predictability in access and pricing, I feel, would go much further in accomplishing what the ACA wanted to initialize.

Whatever the Republicans decide to pass in terms of healthcare legislation, it is sure to do little in the way of reducing real costs and will likely only exacerbate the problems enumerated above. I am under no delusion that a more socialist-styled healthcare system would resolve all the problems we experience, but I am confident that many of the most often articulated concerns patients have would be addressed if this country moved in a more leftist direction on the subject. If tempted by the sirens of the reactionary right, ask yourself this: would you be willing to forgo a private room and cable TV if it meant you could leave the hospital with little to no expense? Canadians don’t die in hospital any more than Americans just because they have socialized healthcare. Britons don’t get less effective or lower quality drugs because they have a national health program. If anything, the health and well-being of their citizens is only enhanced by having these programs and because these countries have decided that healthcare is a right and not merely a nice idea.