11 Questions for M4A Supporters, From a Swede
Take it from a Swede: Universal healthcare is complicated. Before attempting to implement it, supporters must first agree on some important details.
Dear Readers,
Whenever universal healthcare, i.e. Medicare for All (M4A) is debated, the discussion tends to focus on costs. Supporters claim total medical expenses would go down, whereas opponents claim the opposite. While the economics of universal healthcare is an important topic, I would like to highlight another important yet much overlooked issue: As of right now, there is no specific proposal for how to actually implement M4A. It is easy to understand why, considering that any such proposal would have to answer a number of difficult questions on what specifically would be covered under the universal healthcare program.
Here are 11 questions that a serious universal healthcare policy proposal need to answer:
1) Should dental care be covered? In Sweden, this is not the case. While healthcare is free, dental care is merely somewhat subsidized. Many Swedes, especially those on fixed incomes, live with chronic pain due to dental issues that they cannot afford to have treated. The U.K. is slightly more generous, but Brits still do have to pay for dental care.
2) What about ophtalmology? If you need glasses, should the taxpayers cover it? After all, loss of vision is a health issue. On that note, what about laser surgery?
3) How many cancer screenings would each person be entitled to, annually? There are hypochondriacs who might get screened weekly if it were free (I used to be one!).
4) Should patients pay more if they themselves caused their ailment? A classic example would be a smoker who develops lung cancer. Or what about a drunk driver who is badly injured in an accident caused by their own reckless behavior? Should taxpayers still be on the hook for the full cost of treatment?
5) On that note; what about weight loss surgeries, such as gastric bypass? One can argue that these very expensive surgeries are optional, as no-one strictly speaking needs a gastric bypass surgery to lose weight, and that those who are obese have made bad lifestyle choices that they need to take responsibility for. On the other hand, gastric bypass surgeries do no doubt save lives.
6) Plastic surgery: Yay or nay? If the plastic surgery is for a burn victim, or for someone born with deformities of some kind, I think most would agree that the surgery ought to be covered under a universal healthcare regime. I also think most would agree that breast augmentation should not be covered, that is unless the patient is a breast cancer survivor or similar. But what about more minor “beauty flaws”? Many women feel that the stretchmarks they develop during pregnancy affect their mental health, because they no longer feel comfortable with the way they look. Should taxpayer-funded healthcare cover laser treatment to remove stretchmarks?
7) What about alternative medicine? Should the government fund homeopathy? In the U.K., the answer is No, while in Sweden, it’s Yes (although it is restricted). Millions of Americans swear up and down that they are helped by homeopathy, or by realigning their chakras, or by aroma therapy, despite the lack of scientific support for such treatments. The year is not even a week old, which means that countless people are no doubt still undergoing “colon cleanses” to remove the “toxins” from their bodies. Should coffee enemas be taxpayer-funded?
8) What if a patient refuses a traditional treatment on religious or ethical grounds? An example might be a Jehovah’s witness who refuses a treatment that involves blood transfusion. Suppose there is an alternative, scientifically supported treatment that does not require blood transfusion, but that this treatment is more expensive. Should the Jehovah’s witness patient have to pay the difference? What if he/she can’t afford it?
What about a vegan who refuses a medication that is made from animal byproducts, or that was developed using animal testing? Should vegans be able to demand “cruelty-free” healthcare, even if this ends up costing the taxpayers more? What if the patient is vegan for religious reasons, does that make any difference?
9) Should patients be allowed to discriminate? Suppose an African-American patient demands to be treated by an African-American doctor, because he/she fears being discriminated against and/or not being taken seriously by a white doctor. Should this be accommodated? What if the tables were turned and a white patient refused treatment from a doctor with an ethnic minority background? What about women who may prefer a female OB/GYN?
10) More generally, under what circumstances should a patient be allowed to change doctors? Should the patient have to prove medical malpractice? That can be quite a lengthy process. But on the other hand, if patients can change doctors for no reason at all, consumer discrimination is all but inevitable (i.e. women switching until they get a female OB/GYN, racists switching doctors until they get someone who is white etc.). A patient whose doctor refuses to prescribe them opioids may also simply change doctors - for free - until they find someone who will. For context, here in Sweden, patients do not have a legal right to change to another doctor.
11) Would provision of healthcare be based purely on need, or would privilege be taken into account? I am asking as I am concerned that certain U.S. progressives’ obsession with “reparations” may lead to demands that patients from disadvantaged groups be provided with healthcare ahead of other patients - creating a sort of “underprivileged VIP lane” to the now-government controlled health care. Suppose two patients, one black and one white, both suffering from cardiac arrest arrive at the same time to a hospital, and suppose that there are only enough staff available to treat one of them at once. Should the decision of whom to treat be made purely on medical grounds, or should race factor into the equation?
It is possible that proponents of universal healthcare can agree on the answers to all these questions, though I personally remain skeptical. The public’s support for M4A, often touted by progressives, may also shift depending on how these questions are answered.
As a Swedish citizen, I am obviously familiar with both the pros and the cons of our healthcare system and of universal healthcare in general. My dad is a medical doctor, and I have nothing but respect for my country’s healthcare workers. Nevertheless, I would urge caution to any American considering going down our path. The questions I listed above, and the progressives’ difficulty in outlining how M4A would work, is merely one reason why universal healthcare is a bad fit for America, and I will certainly return to this topic in the future. For now, I wish you all a great day.
Sincerely,
John Gustavsson, PhD