Dale Carnegie, a poor boy who made good by creating the perception that he was old money, gave me one of my guiding principles in his book How to Win Friends and Influence People . He wrote, "No matter how right you think you are, you may be wrong." Carnegie reminded readers of their stock market dealings and other bad investments.
Also, I remember a confused traveler requesting directions from Maude Frickert (comedian Jonathan Winters) and the reply was, "I know where it is but you can't get there from here."
Both quips play well when looking at current national issues and particularly health care concerns. I would suggest a health infrastructure meltdown with the uninsured now surpassing 48-million people and half that number inadequately insured. Deficient protections for health care affect every American community.
Compounding the problem is the cost of pharmacy. Recently, I tried to fill a prescription for eye drops; the 10 milliliter bottle would have cost $40 with my pharmacy coverage. The retail price was $56 making for a pricey little bottle of eye suspension. While considering the purchase, I saw a senior citizen refuse to accept his medicine due to the high co-pay then drive off in a huff. I joined him after I didn't take mine either. I settled for a $3 bottle of saline eye wash.
Of the industrialized nations, only two do not provide universal health coverage, South Africa and the United States. It is approximated that 18,000 Americans, a conservative estimate, will die annually because they are uninsured. Understand, that is more than six times the number killed in the tragic Twin Towers terrorist attack. The result of our fractured health care system makes for some very unhealthy statistics. The most watched statistic - infant mortality (the number of babies that die within the first year of life) - has notched upward from 2000 to 2003. The United States had experienced a decline in infant mortality since the 1960s. We lag far behind other countries such as Japan, Sweden, France, Canada, and Germany. Those countries provide universal health coverage to their citizens. We are ranked 28th in the world and sit beside Croatia, Lithuania and Taiwan in baby deaths during the first year of life.
Infant mortality represents a barometer for a nation's health. The fact that no other nation equals U.S. spending per citizen for medical services makes for a very disturbing picture for health care equity here. Compounding this bleak assessment are employers reducing health care benefits to employees creating more pressure on a beleaguered health care system. Add Medicare and Medicaid cuts and expect significant expansion among the ranks of the uninsured and underinsured.
A glaring example of an ailing health infrastructure relates to inadequate flu shots and no effective plan for distribution. Vaccine availability problems have occurred three times in four years. Fortunately, our influenza seasons have been relatively mild but that could change quickly with bird flu or the potential for other anticipated serious strains.
Our nation's ability to respond to bioterrorism, new disease, or dangerous flu bugs requires integrity of purpose, not a two-step when recommending a fix. Our elected officials are not solely to blame for the inadequacies of health access. Our major health care insurers, suppliers, pharmaceutical manufacturers and professional physician organizations have thrown up blocks every step of the way relating to health care equity instead of cooperating. Although there are clearly two solutions to provide universal health care to Americans, little is done to recommend either.
Suggestions of tax credits, broader managed care and creating targeted programs such as Medicaid do little to resolve the uninsured problem or make for a more efficient provision of medical services. It's time to take the bull by the horns. President Richard Nixon offered mandated employer health coverage and rules for insurers as the cornerstone of his plan. Hawaii adopted it and become the first and only state to offer universal health coverage for its residents. The state still ranks high in reduced numbers of uninsured.
A Hawaii friend mentioned availability of health care as a reason for remaining in Kauai. Expanding the Hawaiian plan became impossible because of lobbyists and political disfavor. No other state ever adopted employer mandates. Such mandates across the board would be very effective in minimizing the uninsured. Now it is unlikely, considering the woes of Ford and General Motors, that employer mandates could gain traction. Only one other effective option remains: a national health plan. Sage advice when buying real estate is "location, location, location." Counsel to resolve the health coverage crisis is, "national health plan, national health plan, national health plan."
The above opinions are mine, not the Florida Department of Health or the Pasco County Health Department.
--Dr. Marc J. Yacht is director of the Pasco County Health Department. Guest columnists write their own views on subjects they choose, which do not necessarily reflect the opinions of this newspaper.
