Some thoughts on ecology, evolution and economics

Wallets and whitecoats

Doctors provide an essential service: they make us well. Shouldn’t they be paid for this? More specifically, shouldn’t those who have wealth or foresight have better access to care than those who can’t or won’t prepare for injury or disease? These are the questions that challenge the concept of universal health care. Yet, except in the United States, there is a real prospect that universal medical care will be available to all people from all nations in the coming decades. How can such a technological and social advance be possible in all nations regardless of their prosperity or political system?

Modest goals

The World Health Organization defines essential health services as those surrounding birth (sexual. maternal and child health) , three infectious diseases (HIV, malaria and tuberculosis) and the most common non-communicable diseases (diabetes, heart and lung disease). The focus is on primary care, especially  in rural areas.  This latter condition requires significant investment around the world to provide electricity and running water to rural clinics – a challenge, but one that today’s technology is prepared for. The lack of emphasis on highly trained personnel and experimental or expensive treatment puts the goal of universal health care by 2030 within reach. What is remarkable is how close we  are. Already 80% of the world’s nations have free primary care and 60% have universal health care. Africa and North America (including the Carribean and Central America) lag behind in these developments but universal healthcare is already a reality in Europe, including Eastern Europe, and much of South America.

One of the key aspects of universal health care is taxation or some form of health insurance premium that prepares the medical system to treat people when they inevitably have children or fall ill. This type of funding can be successfully extended through foreign aid but aligning priorities and building trust between donors and local health services can be tricky.  The financial component of universal health care is its least politically palatable requirement but there is an argument for it.

Why treat everybody?

The strongest argument for universal health care is epidemic control.  Without primary care around the world, the risk of an ebola-type epidemic is greatly increased.  Though highly infectious and lethal viruses need special teams and procedures, they are much easier to contain in a country where there is already a primary care system.  This is an echo of the original argument for public sanitation.  Until everyone is protected from diseases like cholera or ebola,  no one is.

A more localized argument for universal health care is the benefit to the economy.  Developing countries have dramatically increased the life span of adults through investments in health care.  These longer, healthier lives, in turn, are responsible for 11% of these countries’ further economic growth. As many as 100 million people around the world are pushed into poverty every year through catastrophic health care costs.  Relieving this anxiety through universal health care can unlock productive potential in low income economies. There is also a temporary “demographic dividend” that comes about through reduced child mortality.  This leads to smaller families, an increased ratio of workers to dependents and better economic productivity – at least until the longer-lived workers start to retire.

The moral argument for universal health care is perhaps the least compelling for those concerned about the role of government in regulating healthcare, even though it has been present in the UN’s Declaration of Human Rights since 1948  and is implicit in the teachings of Jesus, Mohammed and the Buddha. The morality of healthcare carries the argument further than enlightened self-interest.  By including the weakest, least prepared and least healthy in our definition of local and global community, we come to a more rounded sense of self.  It also allows us to address the arguments of medical entitlement and profligate living brought up in the first paragraph.

Doctors, researchers and patent-holders are valuable and deserve compensation.  However, their work is defined by the needy. It is cruel to apply a strictly capitalist model to reward their sometimes heroic efforts.  Those who do not prepare for medical bills are taking a risk but our humanity is defined by more than our ability to anticipate suffering. A true community allows its members to learn from mistakes or misfortunes, not to be condemned by them.