Universal Healthcare The other day, I saw a patient with possible tarsal tunnel syndrome. A few years prior, she’d had a ganglion cyst removed from the medial aspect of her ankle.  She did well until about a year ago, when she started noticing ankle pain radiating to the plantar surface of her foot.  On exam, I find nothing abnormal other than diffuse swelling.  The rest of her anatomy (tendons, joints, ligaments, neurosensory) is intact. It sounds a lot like tarsal tunnel syndrome by history, right?  What would your next step be in this case?  In my opinion, an MRI makes the most sense (perhaps an EMG to document the nerve conduction loss).  Prior mass, surgically removed, with recurrent symptoms – does she have a recurrent soft tissue mass compressing the tibial nerve?  Well, here’s the challenge: after a recent divorce she has no health insurance.  Now what?

Jarrod Shapiro, DPM PRESENT New Docs Editor Joined Mountain View Medical & Surgical Associates of Madras, Oregon July 2008

Obviously, I’m not an expert in national healthcare systems, and I don’t pretend to have even the vaguest shadow of a hint of an answer.  However, I do have an opinion (What else is new?  Shapiro has an opinion).  Let me state at the outset: I am a proponent for universal healthcare.  I’m probably very much in the minority, writing to physicians, but I think it’s important for you to be aware of my bias.

As a young doctor, I did not grow up in the “good old days” of medicine when, as several of my older colleagues tell me, physicians were paid significantly more for their services than we are now.  I’m sure for these doctors, making less than they did previously is a hard pill for them to swallow (it would be for me as well).  In the case of us young docs, perhaps ignorance is bliss—we don’t know what we’re missing.

My concern, though, is not with physician pay—important as it is—but rather providing our entire population with healthcare coverage.  In the wealthiest country in the world, why do so many of our fellow citizens not have healthcare?  The Organization for Economic Co-Operation and Development published a study February 2009 regarding healthcare in the United States and how we compare to the 29 other members of their organization.  See www.oecd.org for information about the OECD. Their study turned up some surprising data. 

1. US overall life expectancy, though increasing, is increasing at a rate lower than many of the OECD members.
2. There is an increasingly large gap between life expectancy of socioeconomic groups in the US vs. other OECD members.  This is contrary to the stated goals of our US Health and Human Services Department.
3. Infant mortality rates in the US (7/1000 live births) are higher than the OECD average (4/1000 live births).
4. Total healthcare expenditures per capita were significantly higher in the US than other OECD countries. 
5. Physicians in the US earn greater incomes than most of the OECD members.
6. More advanced technologies such as MRI and CT are available in the US (ex. 26.5 MRI units/million people) than any other country other than Japan (ex. 40.1 MRI units/million people).

So, in spite of our higher spending for healthcare than other industrialized countries and access to expensive doctors and technology, our health outcomes are significantly poorer compared with these other countries.  Is this due solely to a lack of universal health care?  I don’t know.  I do find it suspicious, though, that of the 30 countries who participate in the OECD (most of which have better outcomes than us) only three do not have universal healthcare: the United States, Turkey, and Mexico.

Additionally, as the economy worsens and more people become unemployed, more of our citizens will become uninsured, leading to increased use of emergency services or deferring care, with potentially more advanced disease and associated cost.  We’re all well aware that health insurance coverage has become a significant portion of business operating costs.  How, for example, can US car manufacturers compete with the Japanese, when a significant portion of their costs are for healthcare?  Obviously, this isn’t the only reason for their failure, but it is a significant expense for private industry.  For those of you physicians who still provide private healthcare to your employees, wouldn’t you rather eliminate this cost from your balance sheet?  According to the National Coalition on Health Care, employer-based healthcare costs rose 5% in 2008, two times inflation (https://www.nchc.org/facts/cost.shtml).  We also know that rising healthcare insurance costs are a major reason for personal bankruptcies in the US.

With all of the effects healthcare costs have on our society, is universal healthcare the answer?  I think it must be at least part of the answer.  The system we have now is neither efficient, affordable, nor sustainable.  We need a change soon, or our system will eventually collapse under its own weight.  What are your thoughts on universal healthcare?  Panacea or pickle?  Write in with your thoughts and opinions. 

Keep writing in with your thoughts and comments...we'll see you next week. Best wishes!

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

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