I am sick and tired of all the news hype and political rants about health care reform turning the fractured US system into ONE giant government-run health care plan. That is just not going to happen. Canada has a single-payer, government-run health care system. There is no private health care in Canada. This is an exception and not a rule for strengthening and expanding health insurance coverage and service access.
For example, last month I was in Costa Rica. Costa Rica has a government sponsored health insurance plan that covers all citizens. Citizens are required to pay into the plan whether they use those services or not. Those who seek faster or more specialized health care services can pay more for private insurance and seek private health services, as well. While the system may not work perfectly, it leaves no one behind. In fact, I was asking my Costa Rican friend where she would go if she had a major medical problem (say a diagnosis of breast cancer). She said she would absolutely, hands-down have her surgery at the public, government hospitals because the physicians are better skilled and trained for those intense surgeries.
Now, in many ways Costa Rica can be quite exceptional. However, it goes to show that government services do not have to lag behind those of the private sector. All too often we assume that government services will be below the standard of private insurance. My experience working at the Veterans Affairs in Palo Alto taught be otherwise. Sure, it wasn't perfect -- but it was light-years ahead of some other private providers.
If planned appropriately and with the right incentives, there should be no reason why US health care reform cannot maintain high quality health care (...and there is improvement needed in this area as well...) while lowering costs and covering all Americans. We should expect exemplary government-run health care (including Medicare, Medicaid, and VA health care) that creates a gold standard for private practices.
But we must not forget that good health is NOT simply a matter of medical care. Prevention is key to improving our health and lowering costs. We must promote health in our homes and in our communities. Without changes in our lifestyle and the societal pressures that surround us we will never be able to sustainably lower costs and increase our health outcomes. We can prevent heart disease, cancer, suicides, and HIV/AIDS without expensive medical technologies and overpaid specialists.
And when I say 'We' I mean 'We' and not 'Me' or 'You'. Because I believe health is a product not just of individual choices, but of social and community influences and environments. Steps to improve our nation's health and our health care system must proceed accordingly.