Universal Personal Care

The concept of universal care is not a panacea, but it may be better for more individuals than what we offer today. Whether it is delivered by the government or by the private sector, however, it will be subject to political manipulation as well as exploitation by commercial enterprises.

One example of political influence that is already happening in government-sponsored care is that the Health Care Regions around the country have different Medicare reimbursement criteria for some of the same services. Much of this is the result of variations in lobbying success among regions.

The British health system often is held up as a model of universal care. Its apparent success in controlling costs since its introduction in 1948 is attributable to three major factors. First, capital expenditures were postponed. For 40 years, no new hospitals were built.

Second, physician reimbursement rates were progressively reduced. Many of the physicians employed in their system today are immigrants willing to accept lower salaries.

Third, care has been rationed. The British temperament and culture is much more tolerant of rationing than we are in the US.

With the unrelenting rise in the cost of care in the US, rationing will be required here, too. However, our method of rationing will have to accommodate Americans’ strong sense of fairness. Further, the US need for individualism will result in a medical system with its own special characteristics.

Compassionate and personalized care can help moderate costs and accommodate the American requirements for fairness and individual treatment. Perhaps this should be termed, “universal personal care.”

Norman Makous, M.D.

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