E duardo K atchburian*
H e a lth fo r a lI, o r n o t?
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u ro p e a np u b lic ly in d u s tria liz e ds u p p o rte d h e a lthc o u n trie sin s u ra n c eh a v e in s titu te ds y s te m w itha th e id e a th a t e v e ry o n e , irre s p e c tiv e o f in c o m e , s h o u ld h a v e fre e a c c e s s to a n a d e q u a te le v e I o f h e a lth c a re . T h is o c c u rre d m a in ly a fte r th e S e c o n d W o rld W a r a s p a rt o f a c o m p re h e n s iv e p a c k a g e k n o w n a s th e w e lfa re s ta te . T h e in d iv id u a l w a s to b e lo o k e d a fte r b y th e s ta te fo r h is l h e r e n tire life .T h is m a y s e e m id e a lis tic , b u t th e fa c t is th a t a re a s o n a b le fo rm o f u n iv e rs a l h e a lth c a re h a s b e e n a c h ie v e d . It is u n d e n ia b le th a t th e q u a lity o f life im p ro v e d d ra m a tic a lly in th e U n ite d K in g d o m , th e B e n e lu x c o u n trie s , G e rm a n y , F ra n c e , a n d o th e r d e v e lo p e d n a tio n s . T h e n o ta b le e x c e p tio n is th e U n ite d S ta te s , w h ic h re m a in e d fa ith fu l to th e id e a th a t th e p riv a te s e c to r w a s b e tte r s u ite d to c a te r to th e h e a lth n e e d s o f th e p o p u la tio n .
S in c e th e la te s e v e n tie s , th e re h a s b e e n a re v iv a l o f 1 9 th c e n tu ry id e a s o f e a rly c a p ita lis m o M a rk e t e c o n o m y , m o n e ta ris m , n e o lib e ra lis m - a H m e a n in g th e s a m e - a re n o w th e ta lk o f th e to w n a g a in . T h e s tu p e n d o u s fa lI o f th e s o -c a lle d s o c ia lis t-c o m m u n is t c o u n trie s h a s fu rth e r c o n trib u te d to a d is tru s t o f a H s ta te -m a n a g e d e n te rp ris e s . It s e e m s th a t a ll fa ith in h u m a n a ltru is m a n d d e s ire fo r a n e q u ita b le s o c ie ty h a v e b e c o m e a n a c h ro n is m s w h ic h s h o u ld b e re g a rd e d a s p a rt o f h u m a n h is to ry . T h u s , in te re s t in u n iv e rs a l h e a lth c a re , a s o rig in a H y c o n c e iv e d , is d e c lin in g .
* FuI! P rofessor chairm an of the D epartm ent of M orphology, Form er V ice R eitor of U N IFE S P -E P M , Form er P rofessor, R oyal London H ospital, London U niversity
H o w e v e r, it m u s t b e e m p h a s iz e d th a t th e q u a lity o f h e a lth in in d u s tria liz e d E u ro p e to d a y is th e re s u lt o f a s ta te -m a n a g e d h e a lth s y s te m . T h is is m o re e v id e n t in th e S c a n d in a v ia n c o u n trie s a n d in th e U n ite d K jn g d o m .
In th e U n ite d S ta te s , w h e re a n a tio n a l h e a lth s e rv ic e -d o e s n o t e x is t, th e re a re m ilio n s o f p e o p le w ith o u t a -d e q u a te h e a lth c o v e ra g e . E a rly a tte m p ts b y th e C lin to n a d m in is tra tio n d o s o m e th in g a b o u t th is h a v e fa ile d . T h u s , w h a t w e k n o w to d a y is th a t th e re is n o e v id e n c e th a t a p riv a tiz e d h e a lth in s u ra n c e s y s te rri a lo n e w o rk s . T h e id e a th a t p riv a tiz a tio n is a p a n a c e a fo r a H iU s w h e n fin a n c ia I re s o u rc e s a re lim ite d , d o e s n o t s e e m to fit th e c o n c e p t o f e v id e n c e b a s e d m e d ic in e .
P riv a te h e a lth in s u ra n c e h a s a im p o rta n t ro le to p la y , n o d o u b t, b u t w iH n o t p ro v id e fo r e v e ry o n e . A H in s u ra n c e p o lic ie s h a v e a lo n g lis t o f e x c lu s io n s w h ic h le a v e th e in d iv id u a l a t th e m e rc y o f G o d . A n d a s th e in d iv id u a l a g e s a n d h is /h e r in d iv id u a l in c o m e fa lls , in s u ra n c e p o lic ie s b e c o m e m o re e x p e n s iv e . A n e ld e rly p e rs o n is a lia b ility fo r a n in s u ra n c e c o m p a n y , a n d a p riv a tiz e d s y s te m , heI
s h e m a y b e a s k e d to le a v e th e in s u ra n c e s c h e m e o r to p a y e x o rb ita n t fe e s . A n d w h a t a b o u t th e d is a b le d a n d c h ro n ic a Il y i Il?
It s e e m s th e re fo re th a t th e s ta te m u s t - in s o m e w a y o r a n o th e r - b e in v o lv e d in h e a lth c a re (a s in e d u c a tio l1 , a ls o ). If w e a Il b e lie v e in th is , w e m u s t a H w o rk to im p ro v e th e s y s te m . In th e w o rd s o f th e e m in e n t p h ilo s o p h e r o f s c ie n c e K a rl P o p p e r, " M a n h a s c re a te d n e w w o rld s - o f la n g u a g e , o f m u s ic , o f p o e try , o f s c ie n c e ; a n d th e m o s t im p o rta n t o f th e s e is th e w o rld o f th e m o ra l d e m a n d s fo r e q u a lity , fo r fre e d o m , a n d fo r h e lp in g th e w e a k ."
