I write in response to Ms. Lisa Shin’s letter to the editor of March 24, 2018 (link).
The US is the only country in the world that does not have a commitment to Universal Health Coverage, for which there are sound ethical and economic rationale. Universal Health Coverage means ensuring that all people in a country have access to an agreed package of good quality health services, coupled with insurance to protect people financially if they fall ill.
In addition, we spend 18 percent of our national income on health. No other high-income country spends more than 12 percent of its national income on health. Yet, life expectancy in almost all high-income countries is higher than in ours. Even some middle-income countries, such as Costa Rica and Cuba, have higher life expectancies than we have.
These data are only a small measure of how poorly we compare to the rest of the world when it comes to health and our healthcare system. The risk of dying of pregnancy related causes is almost four times greater in New Mexico than in Canada or Australia. A New Mexican mother, in fact, faces about the same risk of dying of pregnancy related causes as women in Albania or China. Falling ill is the leading cause of bankruptcy in India. It is also the leading cause of bankruptcy in the US. It is almost never the cause of bankruptcy in other high-income countries.
I cannot argue with Ms. Shin that New Mexico should strive for a growing economy, better trained workers, a broader tax base, and high paying jobs for all. However, this won’t produce universal health coverage for a very long time, if ever. In addition, employer-based health insurance as we have it now will never produce an effective, efficient, and fair approach to covering all New Mexicans with a basic package of good quality services and related financial protection.
Overall, Ms. Shin’s article misses the point. As someone working in healthcare, she should be highlighting the measures we need to achieve Universal Health Coverage as fast as possible, at least cost, and in the fairest possible way for all New Mexicans. If Ms. Shin believes that single payer is not the way, then she should please give us more ideas of substance about ways to move forward. In addition, Ms. Shin should avoid using words that “raise a red flag”, but don’t mean much, like “socialism”. There is only one country today where the government owns and operates the health system and that is Cuba.
Finally, if Ms. Shin is serious about helping improve the health of ALL New Mexicans, I suggest she study the Singaporean, Australian, Swiss, and Dutch health systems to start. I also suggest she study the way the Norwegians have National Commissions on Ethical and Fair Priority Setting in health. She might then have a much better basis than she has now for helping to enhance the health of New Mexicans.
Editor’s note: Richard Skolnik is the former Director of Health for the South Asia Region of the World Bank; former director for Harvard of an AIDS treatment project for three countries in Africa; the author of the widely used textbook Global Health 101, third edition; and, the instructor for the Yale/Coursera course: Essentials of Global Health. He also taught global health at the George Washington University and Yale.