Defining the healthcare debate in the US

Nowadays, healthcare is hotly debated, and not just for US presidential candidates. Virtually every western country is now grappling with the challenge of how to pay for healthcare for its citizens. The US has garnered much attention in this debate, as it is the only western country that does not have universal healthcare coverage, yet it spends 16% of its GDP on healthcare with equivalent (and in some cases, poorer) outcomes.

Part of the debate centres on whether healthcare is a basic human right: is the US morally wrong for not providing universal coverage or simply shooting itself in the collective foot because sick people ultimately cost society even more money? But there is another, more concrete aspect to the healthcare debate – cost. Who is going to pay for it?

Most of the increasing costs in healthcare in recent years are from technological advances, yet the debate often points directly to the pharmaceutical industry. It is not illegal for pharmaceutical manufacturers to make profits. It is not illegal for them to make big profits. So, why does it bother some people so much, for example, when we hear reports that pharma spends more of its budget on advertising than R&D?

It bothers them because it is not possible to discuss healthcare in strictly dollars and cents (or pounds and pence), as we do with other government programmes, such as maintaining roads or postal services, or even programmes that affect us more personally, such as education and pensions. Healthcare is so personal because it affects our very survival. We have a deeply vested interest in its outcomes. And discussing healthcare rationing or cuts to funding tests our survival instincts, because our very existence is at stake. Hence, we come to view it as a right.

Moreover, in an effort to quantify cost-benefit discussions of healthcare, we demand scientifically-rigorous proof that the interventions work – evidence-based medicine (EBM). But medicine is not an exact science and EBM disregards the art of medicine – the side of medicine that takes into account the individual patient and his/her personal life story and circumstances. Evidence-based medicine tries to apply a one-size-fits-all solution to every single human being, the most complex creatures on this planet.

Governments, healthcare providers, insurers, and patients all turn to health economists for answers to these complex questions, and health economists have tried to balance the moral argument of a basic human right and the strictly economic argument of monetary value with concepts such as human capital and quality-adjusted life year.

In the end, healthcare is neither a basic human right nor a strictly cost issue; it lies somewhere in the middle. For societies that can afford a universal healthcare plan, it should be provided. The question for the US is, with a $9.5 trillion debt and no end in the foreseeable future to a costly war, can we afford it? And if we can, it should not be a standardised federal programme. Rather, it should be state-run programme, so that EBM can be adapted to more local needs.