Universal Health Care in America: A Middle East Perspective

Universal Health Care in America: A Middle East Perspective

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Universal Health Care in America: A Middle East Perspective

My project over the course of the program abroad was a focus on the health care systems of the countries we visited. This project was chosen for personal reasons, as I aimed to analyze the feasibility of a universal health care system in America. In order to understand the practicality of such an issue, I had to first understand the encompassing components: economy and politics.

The intrinsic nature of the program itself helped me to understand the politics and the history that set the precedent for contemporary issues, but exploring the economy took a bit more work. My main source of information came from the internet, especially from web sites for such organizations as the World Bank, the International Monetary Fund (IMF), the World Health Organization (WHO), USAID, and various other economic forums. I learned a lot from these web sites, but the main thing I learned is that when it comes to an issue that is as expensive, convoluted and touchy as health care, nothing is cut-and-dry. When it comes to the quality and sustainability of people's lives, as the issue of health care does, people and programs abound to address the problems at hand. But the colossal scope of the issue that 'universal health care' implies is daunting, not only in the richest country in the world (America), and especially in poorer countries (Turkey, Morocco, Egypt).

I learned that health care is an issue that many governments cannot afford to touch. This is why organizations like the World Bank and WHO focus huge amounts of cash and manpower to addressing the issues of people that do not have a voice, like the rural poor in Morocco. If the World Bank did not report on the conditions of such people, how would the world ever know that "84% of the world's poor shoulder 93% of the global burden of disease while only 11% of the $2.8 trillion spent on health care reaches low and middle income countries (Preker & Carrin)."? How would we know that the underlying reasons of the poverty-stricken health care deficit is the result of such simple matters as lack of government accountability for the health care system, and the haphazard and intermittent redistribution of funds set aside strictly for health concerns?

This issue of money spent on health care is not only one for the poor countries.

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Since my original focus was to find out why America cannot or will not support a universal health policy, I decided to concentrate on how poorer countries can. The best example is Egypt, which provides at least a modicum of health care to 100% of its rural and urban citizens, despite the fact that it spends only 3.8% of it's GDP on health care (well below the MENA average)(www.who.int/en). Egypt cannot afford to give specialist health care and medicines to all of its citizens. Worldwide, "As much as 80% of total health care expenditure in low-income countries comes from direct out-of-pocket payment by patients. Studies in several countries found that large medical expenditure (such as for inpatient hospital services and costly outpatient drugs) is a major cause of poverty (Preker & Carrin)." This is exactly the case in Egypt, where about 60% of outpatient drugs are paid for out-of-pocket (www.who.int/en). And yet, Egypt is able to meet the basic health needs of its people to such an extent that all threat from communicable diseases has been eliminated. Such killers as malaria, which are so prevalent in the rest of Africa, are no longer an issue in Egypt (www.who.int/en). The government has even taken steps to solve its micro-inefficiency problems, and has established conferences and brought in consultants to help address hospital management, the training of hospital personnel, and the efficient allocation of government resources to a powerful and accountable Ministry of Health that oversees all of Egypt's public health centers.

This all looks great, from an Egyptian standpoint. They are doing a lot of positive infrastructure restructuring with relatively few domestic resources. For a country without a significant tax base, I have learned that is a difficult thing. In Morocco, 2 ½ million people are considered poor even by Moroccan standards, "of whom 72% live in rural areas and more than half are extremely poor (Understanding.)." Taxing the poor is not something a government can do, even a government such as Morocco's, where the king is not accountable to a higher power. In Morocco, the poor cannot be taxed because they do not have jobs, and do not have an income. The poor also do not have a political voice, since they have no money (Feldstein). And money is power.

This is easily seen in America as well. The American poor do not live in abject poverty, as the Moroccan poor do. And while the middle class in America is easily the largest economic block, there are approximately 41 million uninsured persons in America (Ernst & Young), many of whom are not even poor. The thought crossed my mind that so many poor and uninsured persons should also constitute a large voter percentage, and as such could formulate into an impressive electoral force. Unfortunately, the poor generally do not have a voice in political affairs. "There's no American Association of Uninsured Persons issuing report cards on candidates or holding feet to the fire," says a New York Times associate in an article focused on American health care. This problem is exacerbated by the fact that American voter turnout has been poor in recent times. In the 2000 elections, 92% of those who voted had health care insurance (www.nytimes). This gives political candidates no incentive to change anything.

In fact, candidates have retrograde incentive to change the health care system. In America, there are a few issues that you just do not touch if you want to stay in politics. In no particular order: abortion, homosexuality, and then comes health care issues like Social Security, Medicaid, and health care reform. You do not mess with old people's medication, you do not try and tax people and tell them that it's for the benefit of future generations, and you sure as heck do not try and give poor people a tax increase to force them to pay for their own coverage. When Bill Clinton addressed the issue of health care reform in 1994, the political result was a Republican coup of what was a Democratic Congress, which led to many fights and hardships for the Clinton administration (nytimes).

In light of that last comment, it is apparent that the issue of health care reform has been addressed. It has been recognized, and it has been assessed. Political players and media analysts have reported, recorded, and examined the situation. To give all Americans health care coverage, the government would have to spend another $69 billion a year (nytimes). That sounds like a lot, but it is a drop in the lake considering that we already spend some 14% GDP on health care spending (worldbank.org). With a GDP of almost $11 trillion, we make more revenue and spend more money on health care per capita than any other country on earth.

And yet nothing is done. America has persevered in the face of extreme obstacles before, World War II and 9/11 among them. And yet, a cheeky and rather morbid way of looking at this problem is that each year about 12,000 Americans die from complications that can be directly linked with a lack of health care (Engler). That is equivalent to four 9/11's! And I ask myself, how can this be? Is it due to political accountability? Even in Turkey, the current party in power finds it difficult to pass unpopular legislation that it could be held accountable for. Health care is a very unpopular issue, as fixing it would require taxing the informal sector (the working poor). Due to the large income gap between the rich and the poor in Turkey, tax reform is a major problem. The rich have all the power and money and use that influence to shirk taxes, and the poor have no power and money and refuse to pay taxes.

But that is not exactly the case in America. There is a large income gap between the rich and the poor, sure, but the middle class is also the majority. To answer this question for myself, I had to look to another area: the domain of special interest lobbying. "Insurance companies, for-profit hospitals, pharmaceutical companies, and doctors. oppose universal health insurance. They are powerful political players. Since late 1999, U.S. health care lobbying spending has consistently passed that of any other industry (Engler)." In short, many powerful people are getting filthy, dirty rich off of a lack of universal health coverage. Many people are getting rich because insurance companies have stopped supporting cheaper, generic brand medications in place of expensive name brands that are not covered in low-premium insurance plans. This means that the average person with a basic health insurance plan must pull more money out-of-pocket to pay for medications that their insurance will not cover and their doctors cannot or will not recommend.

Up to this point, I had not been able to realize how deliberate and obvious this issue is. But the contentiousness really hit home when I was reading America (The Book) by John Stewart, a quirky publication on how American democracy works. He states that the Pharmaceutical Lobby is said to have given almost $27 billion in 2000, and everyone from Democrats to Independents are cashing in on the benefits. He sites the Secretary of Health and Human Services as no more than a prescription drug tv commercial regulator, and a good position to plug in a minority on the cabinet (Stewart). A mockery is made of the health care system, and yet, the health care system has so very much to be mocked.

The benefits of my study have been fruitful, but I am ultimately stymied. The issues are blatant, yet strangely unresolved. I have been accused of being unclear in my presentations, and assuming with my information. In reality I feel that the issue is ambiguous in my own mind, and the statistical information is window dressing at best. I have researched my project to the ends of the internet and back, and have been through every book that the limited libraries of the Middle East and Greece have afforded me. Apparently I have been unable to present a complete and accurate picture of the health system situation in Turkey, Morocco, Egypt, and Greece. But at the very least I have personally come to grips with the complete and utter absurdity that is the American health care system, and I am confident in the resolution that I have affirmed: that the universal health care situation is not hopeless. Far from it, the situation is close to being worked out, and a small bit of work in the right direction will give 41 million Americans new hope for the future. I now have hope, and I will work toward positive solutions to the problems that afflict the world, and in particular our nation, in the future. Thank you and good night.

Bibliography for Final Paper

1) Engler, Yves. " Rising Health Costs ." Z Magazine, 2004. <
http://zmagsite.zmag.org/Apr2004/englerpr0404.html> .

2) Ernst & Young. World Economic Forum Health Market: Reform in G20 countries. <
http://www.ey.com/global/content.nsf/International/Issues_&_Perspectives_-
_Health_Care_and_the_G20_Necessity_or_Luxury >, 2003.

3) Feldstein, Paul J. Health Policy Issues: An Economic Perspective . 2 nd ed., 1999.

4) New York Times website. < www.newyorktimes.com > (note, I would put the site of the
exact publication down, but articles expire on the New York Times website and the
article is no longer accessible without purchase).

5) Preker, Alexander S. & Carrin, Guy. Health Financing for Poor People: Resource
Mobilization and Risk Sharing . World Bank Book ed., 2004.

6) Stewart, John. America (The Book): A Citizen's Guide to Democracy Inaction . Warner
Books, 2004.

7) Understanding the Contemporary Middle East.

8) World Bank. < www. worldbank .org/ >

9) World Health Organization website. < http://www.who.int/en/ >
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