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October 31, 2007 > Universal Healthcare: Myth or Reality?

Universal Healthcare: Myth or Reality?

A conversation with Anmol S. Mahal, M.D. about California Medical Association views of healthcare options

Universal access to healthcare has become a hot topic for discussion this year. Organizations have formed to promote the concept and a variety of options are being explored to make this a reality. Although the idea of creating equal access for all to quality care is immensely appealing, healthcare is a complex mix of professionals, manufacturers, insurers and facilities. Simple solutions and slogans can be misleading and as is often the case, the devil is in the details.

In order to gain an understanding of how many in the medical profession view this issue, Tri-City Voice newspaper spoke with Anmol S. Mahal, M.D., a Fremont board certified gastroenterologist on staff at Washington Hospital. Dr. Mahal has served in community, regional and national leadership roles, most recently president of the California Medical Association (CMA) and chair of the CMA Board of Trustees.

TCV: How is universal access to healthcare viewed by physicians in California?

Mahal: Physicians in California want every person covered by health insurance. We think that is the only right thing to do. Insurance is the key that opens the door to the healthcare system. The only way to satisfy the needs of our population is to provide universal access to healthcare using that key. We do not believe a single payer system is the right way to do it.

TCV: Why not allow the government to become a single payer for health services?

Mahal: If you look at government run healthcare programs in California such as Medi-Cal, it has been chronically under funded and is becoming more under funded. Medi-Cal patients have a problem getting access to physicians - especially specialists - because the payment structure is inadequate. This is the risk of using a government monolithic system. The government has a role in society, for instance in public safety such as police and fire protection, but we believe health care would not be well served by this approach.

TCV: How can everyone have universal access?

Mahal: As a society, we need to make some decisions. Is basic health care the right of every citizen or a privilege? Physicians of California feel that basic health care should be a right; everyone should have access to basic services. No person should be without necessary medicine or care. We currently impose this by requiring care for the uninsured in emergency rooms through federal regulation. This is inefficient and expensive, with a focus on an acute problem rather than prevention and early treatment before complications set in. After deciding on this basic right, the next major decision will be to define basic health services.

TCV: Should medical insurance be reformed since it appears to focus on symptoms after they cause problems rather than preventive actions?

Mahal: In the past this was true. Insurance coverage has started to change; now many insurance products encourage preventative care such as diabetic diagnosis and care, colonoscopy, pap smears, mammography, etc.

TCV: Care for children seems to be the focus of much debate. Should universal care be phased in beginning with children?

Mahal: The reason health care for children is the often seen in legislation is that while it is the desire of legislatures to cover everyone, they lack the resources to do so. With limited resources, the tendency is to cover the most vulnerable segment of society - our children. It is an issue of resources. If we lived in a world of infinite resources, we would provide coverage for all immediately. The question is not desire, rather resources and the political will to come up with the necessary resources.

TCV: What is the practical approach to this challenge?

Mahal: The governor has proposed shared responsibility based on the present system. Employers, individuals and government would be mandated to provide insurance coverage at certain levels. We support that approach. There is a reason the system is designed as it is and we should build on what we have rather than trying to completely change it without understanding how it would look in a few years.

TCV: In some cases, a small employer may not be able to financially support this system and either decrease payroll or go out of business. Doesn't this defeat the purpose?

Mahal: The devil is always in the details. Small business is clearly the economic engine for the state. The governor has come up with a graduated scale where the smallest and least profitable businesses would pay the least. Whatever we do, when we give this benefit to a large, broad-based population, a secure revenue stream must also be large and broad-based - a statewide income tax, sales tax or graduated employer mandate. The California Medical Association does not subscribe to one avenue or the other. We feel, however, that whatever it is, it needs to be a broad and society based.

TCV: How can this health care plan meet public expectations of full coverage at no cost?

Mahal: It is often said by single payer advocates is that insurance company profits are the obstacle to success of this approach. We partially agree. Healthcare should be a nonprofit business. We believe health plans should be converted to nonprofit status - profits should be cycled back into the system rather than to shareholders and heavily compensated CEOs. We should be using our resources in a more appropriate manner. However, to anticipate that by using present resources everyone can be given full coverage is unrealistic. This will lead to an under funded system.

The U.S. currently uses 16 percent of our Gross Domestic Product for health care. We will need to make a decision about using a greater percentage to achieve our health goals. In the future, associated issues dealing with other areas of health care including pharmaceuticals and technology will also need to be addressed. I believe we have the resources to provide universal health care if we decide to support that goal.

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