Comments

Health Affairs encourages readers to engage in discussion via comments on our Web site.

• To RESPOND to a particular article: Click on the link "Submit a response to this article" in the box at the top right-hand corner of the article.
• To READ responses to a particular article: Click on the link "View responses" in the box at the top right-hand corner of the article.

Comments to:

Jeanne M. Lambrew, John D. Podesta, and Teresa L. Shaw, Change In Challenging Times: A Plan For Extending And Improving Health Coverage, Health Affairs Web Exclusive, March 23, 2005 [Abstract] [PDF] [HTML Version] [Reprints & Permissions]

Comments:Submit a response to this article

Comments published:

Now Is the Time for a Commitment to a Right to Health Care

Jonathan B. Kotch, Dennis B. Lazof, Ph.D.   ( 11 April 2005 )

Fear Of Insurance Company Money: Barrier To Reform?

Ira Laufer   ( 16 August 2007 )

Dispassionate Comments On U.S. Reforms

Raghavan Srinivasan   ( 28 July 2009 )

Now Is the Time for a Commitment to a Right to Health Care 11 April 2005
Jonathan B. Kotch, Professor of Maternal and Child Health School of Public Health, UNC- Chapel Hill, Dennis B. Lazof, Ph.D. Send comment to journal: Re: Now Is the Time for a Commitment to a Right to Health Care jkotch{at}email.unc.edu Jonathan B. Kotch, et al.	Lambrew, Podesta, and Shaw get a lot right in "Change in Challenging Times: A Plan For Extending And Improving Health Coverage." Their assessment is correct that in the range of value systems functioning in our diverse nation, it is usually wrong to tolerate avoidable pain, suffering, and death. They come to the correct conclusion that our nation will eventually overcome the political odds and demand universal health coverage from our representatives. Those representatives will do this quickly once they are made aware of the clear evidence that we are already paying enough to fund such a system with high-quality care and improved health outcomes. There are, however, a couple of important omissions in the authors' discussion. Our democracy cannot flourish and will likely not long survive maintaining barriers around those basic resources which are necessary to provide individuals a fair shot at active participation and creative self-expression. Health care as a privilege for a shrinking class within our society (one in three nonelderly adults uninsured presently and a 25% projected increase in 2013 over 2003) will certainly undermine broad opportunities for productive lives and, even, competitiveness of American business. That the excluded and underprivileged are disproportionately ethnic minorities and largely low-income workers will make obvious the deception of the "American myth" (i.e. hard work and individual sacrifice pays off). This will shake both major political parties. Either health care remains a privilege for some, or it shall become the right of all. Education made this quantum leap many years ago when it was written into 49 state constitutions, after considerable popular demand and mobilization. Before the federal government took any action to support the state-level reforms, a right to education was written into 32 state constitutions. Once we make clear our commitment to health care as a right of all Americans, political mechanisms and, hopefully, a good deal of professional expertise and reasoning from sound data will come to bear in devising and implementing a promising system to fulfill that right. There are many variations of what such a system might look like. The authors of "Challenging Times" present one of those options, which would, at least, nearly fulfill the governmental obligation that the "Right to Health Care" would involve. Other, more efficient and less costly manners of assuring quality care to all Americans certainly also exist. It is obvious that there is no predetermined financial barrier to insuring all Americans. This is clear from the fact that we already spend per capita twice that which other industrialized nations spend to insure their entire populations. It is further supported by estimates of what we currently waste on redundant administration, egregious salaries for top-level administrators, and litigation. This latter is exacerbated by a system founded on distrust and which cedes the central management role to players who are legally bound to act on the basis of "return on investment." Then there is the "uncompensated care" and all the indirect expenses we incur collectively from our failing health care system. Clearly, our experts in public health and in health services research have the ability to fashion an efficient system of providing and funding health care. Now, however, we find ourselves at the point of needing to be clear about just these one or two most poignant and essential facts that every American needs to appreciate: namely, that we already pay for a quality universal system and that we don't get back the quality that we pay for. Our first order of business is to take the step of commitment. That commitment would best be expressed as widespread medical professional endorsement and public demand for a "Right to Health Care" for all Americans.
Fear Of Insurance Company Money: Barrier To Reform? 16 August 2007
Ira Laufer, Retired Send comment to journal: Re: Fear Of Insurance Company Money: Barrier To Reform? iralaufer{at}hotmail.com Ira Laufer	It is almost laughable, yet pathetic, that in all the verbiage spilled about health care, almost no one mentions these two words: "insurance companies." Only lonely Dennis Kucinich among the 2008 presidential hopefuls, with no chance of winning anything, has nothing to lose, so he is adamant about single-payer and doing it without the huge costs of private insurance companies tacking on their 20-30% overhead (including huge profits). Medicare operates at, depending on which article you read, between 2% and 5% overhead. That's the difference between being able to finally become the last modern industrialized country to venture into health care for all. Sidebar to the "laughable" situation. The candidate most identified with health care (it's emblazoned on her Web site) has yet to submit a plan. It looks like all the veterans are deathly afraid of the huge pocketbooks of the insurance industry. Of course, it is something to fear, but wouldn't it be nice to have candidates running without that kind of fear...
Dispassionate Comments On U.S. Reforms 28 July 2009
Raghavan Srinivasan, Visitor to the US from India Does not apply Send comment to journal: Re: Dispassionate Comments On U.S. Reforms vijurags{at}gmail.com Raghavan Srinivasan	I am a spectator watching with interest these debates for the past three months. I am an unbiased individual and am making comments, as I understand it. It could be totally incorrect. For whatever it is worth, I make the following comments: 1. The new policy seeks to cover all Americans into the health care net as 45 million Americans are out of the net. The government seems extremely concerned about this exclusion and is keen to embrace everyone in its nation. 2. The new scheme that government wishes to bring about does not force people to change over from their present system if they are happy and do not want to switch. 3. It allows employers who have not insured their staff or individuals who cannot afford current insurance schemes to take a government insurance scheme and get Medicare. 4. Over time, when the government schemes work well, hopefully many will join from their existing insurance plan, which would bring in economies of scale and consequently drive costs further downwards. This will also bring in more transparency in an area that is opaque today. 5. If item 4 happens, the existing insurance companies will pull up their socks, and such competition will hopefully bring orderliness. 6. Many Americans who are covered by insurance schemes currently prevalent do not seem to be totally happy, heart of hearts. I will be extremely happy if someone comments either way on my observations, as I can learn more.