There is a huge difference between universal "care" and universal "coverage." The former implies that providers work for the government, the latter that everyone has some sort of insurance. Any discussion of universal coverage leads to people running out of the room shrieking about "socialized medicine" when in fact this isn't what is being proposed. Nor is this the model used by all other developed countries. Many of the universal coverage programs around the world are in many ways more capitalistic than the current American healthcare system.

It has often been stated that we spend about twice as much per citizen on healthcare compared to other developed countries (in spite of having many who have no coverage at all). Conservatives and special interests claim that this is necessary to maintain the superior quality of our care. But is it really superior? There are many indices (e.g. infant mortality) that would suggest it isn't. True, many of the world's great medical centers are in America. But does that mean that the average middle-class American is getting better healthcare than the average middle-class European? As a physician, I can't help but notice that medical care around the globe seems to be equalizing. Medical research takes place around the globe, not just in the U.S.A. The medications we take here are essentially the same that they take in Europe, Canada, and Australia. In fact, many of the pharmaceutical giants are based in Europe.

About half of the health care dollars spent today (Medicare + Medicaid + vets, etc.) are now being spent by the government. A large chunk of the other half is out of pocket. Thus, a relatively small portion is actually paid for by private insurance companies. This brings me to the "dirty little secret": We already have socialized medicine. And as Boomers age, the Government will be funding even more. But unlike other countries, our socialized medical sytem is grossly uncoordinated and inefficient. We have the worst of both worlds.

We don't need socialized medicine; what we really need is Walmartized medicine. Now, I'm not a big fan of the folks in Arkansas, but you have to admit that they are on to something. There is a reason why people shop there: The stores are readily accessible and they sell what people want/need at a reasonable price. When I was a kid in a small town, we had to go to "Mom and Pop
Shops" for the things we needed. Mom and Pop didn't do much volume, and they were often the only game in town, so they could charge whatever they wanted. Sure, they were warm and friendly. But you had to settle for whatever they had on their terms. If you were fortuneate enough to live in a bigger city and had more money, you could go to a fancy department store where they had a lot more to offer. Once Walmart came around however, the landscape changed. Now anyone in any town could have access to variety and selection and at bargain basement prices.

Imagine the impact if the federal government became a helathcare Walmart and all the doctors, hospitals, and drug companies became the suppliers. Costs would plummet, as would the profit margins. If you wanted to stay in business, you would have to keep producing a quality product at bargain basement prices. This is of course why the pharmaceutical industry has resisted any collective bargaining with the Governement; they designed the Medicare D program to be a bunch of Mom and Pop Shops. Ironically, a universal healthcare system operated by the Government might actually be more capitalistic than our current system is.

I know that conservatives assume that governement could never run a healthcare system as well as the private sector can. But really, how could it be any worse than it currently is? If you remove the profits of private insurance companies and factor in the efficiency of standardized coverage (rather than the current mishmash of patchwork coverage) it can only improve the overall cost effectiveness.

Our current system is hopelessly gridlocked by special interests including drug companies, insurance companies, and the medical profession. In the end, I believe that this logjam will be broken by Corporate America. It will become an economic necessity; we will not be able to compete globally if we do not simplify our healthcare system and bring down costs. Only Nixon could go to China, and only Big Business can bring us universal health coverage.

As a retail pharmacist I have to contend with our health non-system on a minute by minute basis. The problems are many and include:

what company (claims processor, not insurance company) is currently responsible for controlling your care. many patients,especially the elderly or those that assist in their care don't have a clue who this company is. We can spend as much as 30 minutes per patient working on the problem .

what drugs are currently covered on your plan, in what quantities and has that changed recently? a drug that was covered last week may no longer be on the list (formulary)

what is your copay? most plans have three tier copays based on drug cost and the price negotiated between the processor and the drug manufacturer. in order to be more profitable it is in the interest of the processor to steer your medication regimen to one that is most profitable for it. your best interest and your physician's insight are no longer important

does the drug prescribed require a prior authorization? (it's expensive and we don't want to pay for it) prior authorization is a process your insurance company and/or processor have invented to again maximize profits. to get an expensive or non-preferred drug your physician must call the processor and get approval from someone. the process is time consuming for the pharmacist and physician (read as not reimbursed) and will cause a delay in your treatment. prior authorizations also apply for other things such as non-emergency surgery. drug priior auths can take up to a week. if you don't have insurance and can't afford your medication can we get your doctor to order something less effective but affordable?

what medications are you getting via mail order? mail order is another way for companies to maximize their profits at the expense of your health. They can negotiate with manufacturers of brand name drugs (retail pharmacies cannot do this) because they can have control of what you take. Mail order leads to fragmented care in that your retail pharmacist has no idea what your current regimen is and what problems( eg. interactions, duplications) will be generated by the new medication. oh, by the way, mail order inconvenient and can be wasteful if your doctor discontinues a medication.

i have read that the term socialized medicine was invented during the Truman administration by physicians because they feared government control. what has resulted is the insurancised system that controls healthcare for profit. as many can testify to insuranceisation has lead to an inefficient, expensive health care for about 65% of the population and dependence by the other35% on the majority to cover their care (cost shifting)

do we really believe that this is the best way to deliver healthcare? can't we do better? the battle is ultimately political and it will take a coalition of citizens and business to destroy insuranceisation and put something better in its place.