Universal health care is long overdue

A health care worker at St. Luke's Hospital in Cedar Rapids fills a syringe with rabies vaccine in this file photo. (Kevin Wolf/The Gazette)
A health care worker at St. Luke's Hospital in Cedar Rapids fills a syringe with rabies vaccine in this file photo. (Kevin Wolf/The Gazette)

When I worked for Doctors Without Borders in Africa, my colleagues hailed from Australia, Germany, Japan, Norway, a multitude of countries. They always were baffled by America allowing its citizens to suffer from lack of universal access to basic health care.

The Senate health care bill (BCRA) proposes a 35 percent cut in Medicaid over the next 20 years, in exchange for a tax cut of about $600 billion. Of this tax benefit, 45 percent would go to those earning $875,000 or more. The Congressional Budget Office estimates 49 million would be uninsured by 2026.

In 2015, 48 percent of Iowans in nursing homes relied upon Medicaid to pay room and board (average Iowa cost — $78,110 per year). You might think you never will need this safety net but, as people live longer, those who run out of money rely on Medicaid. How many among us are equipped to take a dependent, elderly relative home?

Also, 37 percent of Iowa children receive medical care through Medicaid. Families with disabled children or adults know Medicaid allows them to live, study and work in the community, at a cost savings compared to institutionalized care.

The Iowa Hospital Association says 10 percent to 20 percent of care in rural hospitals is financed by Medicaid. Their leaders fear reductions in funding would force some to close. There are 84 critical access hospitals in Iowa that care for 3.1 million rural residents, employ thousands in small towns and have a $2.5 billion impact. Which one of our area rural hospitals should close?

In 2013, the Institute of Medicine compared the health status of Americans with that of people in 16 other nations, including most of Europe, Canada, Australia and Japan. American men had the shortest life span, American women the second shortest of these 17 nations. We had higher incidences of heart and lung disease, diabetes and obesity. We had the highest rates of infant mortality and teenage pregnancy. Americans had higher rates of HIV, AIDS and drug-related deaths. We also had a higher incidence of accidental injury and homicide. A root cause of this poor rating was attributed to lack of universal care.

Several studies have looked at whether there is a survival benefit when one has access to care. Perhaps the simplest is a recent comparison of survival rates between U.S. and Canada (which has government-funded health care) for cystic fibrosis patients. On average, patients live 10 years longer in Canada than here. Those in the U.S. with no consistent source of health care have the shortest survival, but those here with private insurance enjoy a life span similar to Canadians.


Another recent study comparing two Medicaid-expansion states to one that did not found mortality dropped by 6 percent over five years with greater Medicaid coverage. Patients had fewer out-of-pocket expenses and emergency room visits. They also used medications more consistently.

We need to ask why we are so willing to relegate the poor and middle class to a medical purgatory. Why do we continue to refute national and international data showing the health and financial benefit of government-sponsored basic medical care?

Why do we provide a wealth of care to those who survive beyond age 65, but create a gauntlet of financial hardship for working individuals? How can we not fund maternal care, mental health services, or address the addiction crisis?

Will we join our fellow industrialized nations in providing a nationalized system of care which can negotiate prices, organize services and reduce cost? Or will we continue down this acronymic path (ACA, AHCA, BCRA), doing the same thing over and over but expecting different results?

• Dr. Mary Kemen lives in Cedar Rapids



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