We all know, and probably all periodically use the expression: for goodness sake! Perhaps it represents well the prevailing cynicisms of modern living that when we say for goodness sake these days, we dont really mean doing something for the sake of its intrinsic goodness. Rather, we use for goodness sake, when we arent using less savory language, to vent exasperation. I will borrow both meanings to make a case for universal health care coverage, because, as a public health professional, I am more than a little exasperated with us, and because this is something we should do for the sake of goodness first and foremost.
Our protection by police is a public good. So, too the protection of our homes and forests by firefighters. And of course, so is the protection of our borders by the military. The U.S. military cannot possibly defend our borders for some of us without doing so for all of us; it is a public good.
Emergency medical care is a public good. The only alternative to that is a society where a financial test is applied before care is rendered to an 8-year-old hit by a car on the way to school. I hope and trust our common humanity recoils at the prospect. Assuming it does, then urgent and emergency medical care becomes a human right. We should treat it as such.
Once we do, there are two immediate implications. The first is that we are going to cover the costs of emergency care for all who need it one way or another, either rationally, or irrationally. The second is that universal coverage of emergency care without universal coverage of preventive care is a guarantee of more emergency care needed, at higher cost.
Advertisement
If the ethical positioning of emergency medical care as a human right is formally recognized, it permits us to plan accordingly. We could acknowledge that such care will be provided both to those who can pay for it, and those who cannot. This, in turn, allows us to determine in advance how best to distribute those costs. The answer is the obvious one, derived from the most relevant precedents: much the way we cover the costs of our military protection. Costs for a given year are estimated and projected, and all who can pay, do- in our taxes. We understand and apparently accept that the military protection our taxes cover will cover those with no means to pay any taxes, too. Such is the nature of public goods.
This approach does not, of course, spare us the need to pay for others along with ourselves. But it does distribute those costs widely, and in the most equitable manner possible. The alternative, applied uniquely to health care, is to make no advance plans for distributing the costs incurred by those unable to pay, and then directing those costs haphazardly after the fact. The results generally range from painfully irrational, to overtly tragic- as when a much-needed hospital serving an indigent community is put out of business.
Second are the implications of covering emergency medical care for all, without covering preventive care. Preventive care, from cancer screening to immunization, is to medicine what surveillance, treaties, NATO, the United Nations, and intelligence gathering are to the military. Viewed that way, the folly of leaving them out of the planning for public good is, I trust, self-evident. Imagine a military that never did anything at all until after we were attacked and imperiled, and ask yourself if thats a satisfactory use of your tax dollars.
In case you are wondering, yes, we do have a source of the reliably evidence-based preventive services that contribute meaningfully, and cost-effectively, to the public good. The verdicts of the U.S. Preventive Services Task Force do not tell us everything we need to know, but we certainly need to know, and should cover, everything they tell us.
What stands in the way of progress and rationality is a toxic blend of cultural arrogance, misguided ideology, and selective blindness. The United States spends more on health care to achieve worse outcomes than many of our peer countries around the world, yet the arrogance of a not invented here mentality seems to preclude us from examining and adopting elements of best practices developed elsewhere. The contention that universal health care coverage is in any way more socialistic than universal military protection is not just ideological nonsense, but nonsense inconsistently applied. The failure to note the place for medical care among other public goods is selective, cultural blindness induced by the glare of ideology where epidemiology should be, and often by willful distractions, distortions, and overt deceptions.
There are many good reasons to preserve and improve the Affordable Care Act, and dollars figure among them. But first and foremost, we should do it for goodness sake.
Dr. David L. Katz; http://www.davidkatzmd.com; founder, True Health Initiative
Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative
Visit link:
Dr. David Katz, Preventive Medicine: Universal care for goodness' sake - New Haven Register
- Yes, But. The Annotated Atlantic. - November 7th, 2009 [November 7th, 2009]
- Health Insurance Benefit Costs by Region - November 8th, 2009 [November 8th, 2009]
- For an Operator, Please Press... - November 8th, 2009 [November 8th, 2009]
- Pollyanna With a Pen: Maine Governor Signs 18 New Health Care Bills into Law - November 8th, 2009 [November 8th, 2009]
- AMA Sounds the Alarm, Medicare Making Yet Another Attempt to Cut Reimbursement - November 8th, 2009 [November 8th, 2009]
- Mass Governor Asks Blue Cross to Keep Higher Employer Contribution - November 8th, 2009 [November 8th, 2009]
- Lifespan and Care New England Plan Monopoly (Again) - November 8th, 2009 [November 8th, 2009]
- Dirigo Health: Con Artists, Liars, and Thieves? - November 8th, 2009 [November 8th, 2009]
- New Orleans: Health Challenges - November 8th, 2009 [November 8th, 2009]
- August a Flurry of Activity - November 8th, 2009 [November 8th, 2009]
- Maine's Dirigo Health Savings One-Third of Original Estimate - November 8th, 2009 [November 8th, 2009]
- “Methodolatry”: My new favorite term for one of the shortcomings of evidence-based medicine - November 8th, 2009 [November 8th, 2009]
- Suzanne Somers’ Knockout: Dangerous misinformation about cancer (part 1) - November 8th, 2009 [November 8th, 2009]
- A science-based blog about GMO - November 8th, 2009 [November 8th, 2009]
- A Not-So-Split Decision - November 8th, 2009 [November 8th, 2009]
- Military Medicine in Iraq - November 8th, 2009 [November 8th, 2009]
- The effective wordsmithing of Amy Wallace - November 8th, 2009 [November 8th, 2009]
- A Science Lesson from a Homeopath and Behavioral Optometrist - November 8th, 2009 [November 8th, 2009]
- Join CFI in opposing funding mandates for quackery in health care reform - November 8th, 2009 [November 8th, 2009]
- Mainstreaming Science-Based Medicine: A Novel Approach - November 8th, 2009 [November 8th, 2009]
- Those who live in glass houses… - November 8th, 2009 [November 8th, 2009]
- J.B. Handley of the anti-vaccine group Generation Rescue: Misogynistic attacks on journalists who champion science - November 8th, 2009 [November 8th, 2009]
- When homeopaths attack medicine and physics - November 8th, 2009 [November 8th, 2009]
- The cancer screening kerfuffle erupts again: “Rethinking” screening for breast and prostate cancer - November 8th, 2009 [November 8th, 2009]
- All Medicines Are Poison! - November 8th, 2009 [November 8th, 2009]
- When Loud Wins: Will Your Tax Dollars Pay For Prayer? - November 8th, 2009 [November 8th, 2009]
- It’s All in Your Head - November 8th, 2009 [November 8th, 2009]
- The Skeptical O.B. joins the Science-Based Medicine crew - November 8th, 2009 [November 8th, 2009]
- The Tragic Death Toll of Homebirth - November 8th, 2009 [November 8th, 2009]
- What’s the right C-section rate? Higher than you think. - November 8th, 2009 [November 8th, 2009]
- Recombinant Human Antithrombin – Milking Nanny Goats for Big Bucks - December 13th, 2009 [December 13th, 2009]
- Does C-section increase the rate of neonatal death? - December 13th, 2009 [December 13th, 2009]
- Man in Coma 23 Years – Is He Really Conscious? - December 13th, 2009 [December 13th, 2009]
- Why Universal Hepatitis B Vaccination Isn’t Quite Universal - December 13th, 2009 [December 13th, 2009]
- Ontario naturopathic prescribing proposal is bad medicine - December 13th, 2009 [December 13th, 2009]
- Naturopaths and the anti-vaccine movement: Hijacking the law in service of pseudoscience - December 13th, 2009 [December 13th, 2009]
- The Institute for Science in Medicine enters the health care reform fray - December 13th, 2009 [December 13th, 2009]
- Neti pots – Ancient Ayurvedic Treatment Validated by Scientific Evidence - December 13th, 2009 [December 13th, 2009]
- Early Intervention for Autism - December 13th, 2009 [December 13th, 2009]
- A temporary reprieve from legislative madness - December 13th, 2009 [December 13th, 2009]
- A critique of the leading study of American homebirth - December 13th, 2009 [December 13th, 2009]
- Lose those holiday pounds - December 13th, 2009 [December 13th, 2009]
- Endocrine disruptors—the one true cause? - December 13th, 2009 [December 13th, 2009]
- Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome - December 13th, 2009 [December 13th, 2009]
- Evidence in Medicine: Experimental Studies - December 13th, 2009 [December 13th, 2009]
- Midwives and the assault on scientific evidence - December 13th, 2009 [December 13th, 2009]
- The Mammogram Post-Mortem - December 13th, 2009 [December 13th, 2009]
- An Influenza Recap: The End of the Second Wave - December 13th, 2009 [December 13th, 2009]
- The End of Chiropractic - December 13th, 2009 [December 13th, 2009]
- Cell phones and cancer again, or: Oh, no! My cell phone’s going to give me cancer! (revisited) - December 20th, 2009 [December 20th, 2009]
- Another wrinkle to the USPSTF mammogram guidelines kerfuffle: What about African-American women? - December 20th, 2009 [December 20th, 2009]
- Acupuncture, the P-Value Fallacy, and Honesty - December 20th, 2009 [December 20th, 2009]
- The One True Cause of All Disease - December 20th, 2009 [December 20th, 2009]
- Communicating with the Locked-In - December 20th, 2009 [December 20th, 2009]
- Are the benefits of breastfeeding oversold? - December 20th, 2009 [December 20th, 2009]
- Measles - December 20th, 2009 [December 20th, 2009]
- Radiation from medical imaging and cancer risk - December 21st, 2009 [December 21st, 2009]
- Multiple Sclerosis and Irrational Exuberance - December 21st, 2009 [December 21st, 2009]
- Medical Fun with Christmas Carols - December 22nd, 2009 [December 22nd, 2009]
- Lithium for ALS – Angioplasty for MS - December 23rd, 2009 [December 23rd, 2009]
- “Toxins”: the new evil humours - December 24th, 2009 [December 24th, 2009]
- 2009’s Top 5 Threats To Science In Medicine - December 24th, 2009 [December 24th, 2009]
- Buteyko Breathing Technique – Nothing to Hyperventilate About - December 26th, 2009 [December 26th, 2009]
- The Graston Technique – Inducing Microtrauma with Instruments - December 29th, 2009 [December 29th, 2009]
- The “pharma shill” gambit - December 29th, 2009 [December 29th, 2009]
- Ginkgo biloba – No Effect - December 30th, 2009 [December 30th, 2009]
- Oppose “Big Floss”; practice alternative dentistry - January 1st, 2010 [January 1st, 2010]
- Causation and Hill’s Criteria - January 3rd, 2010 [January 3rd, 2010]
- The life cycle of translational research - January 10th, 2010 [January 10th, 2010]
- The anti-vaccine movement strikes back against Dr. Paul Offit - January 10th, 2010 [January 10th, 2010]
- Osteoporosis Drugs: Good Medicine or Big Pharma Scam? - January 10th, 2010 [January 10th, 2010]
- Acupuncture for Hot Flashes - January 10th, 2010 [January 10th, 2010]
- The case for neonatal circumcision - January 10th, 2010 [January 10th, 2010]
- A victory for science-based medicine - January 10th, 2010 [January 10th, 2010]
- James Ray and testosterone replacement therapy (TRT) - January 10th, 2010 [January 10th, 2010]
- The Water Cure: Another Example of Self Deception and the “Lone Genius” - January 12th, 2010 [January 12th, 2010]
- Be careful what you wish for, Dr. Dossey, you just might get it - January 13th, 2010 [January 13th, 2010]
- You. You. Who are you calling a You You? - January 15th, 2010 [January 15th, 2010]
- The War on Salt - January 16th, 2010 [January 16th, 2010]
- Is breech vaginal delivery safe? - January 16th, 2010 [January 16th, 2010]