Meanwhile, We Take You to Rwanda
Friday, July 6, 2012
Universal Health Care in the 14th Century
Reading Blossoms Into Gold, a history of the Croatians who emigrated to the Watsonville area 75 miles south of San Francisco, I came across the following: “The Republic (of Dubrovnik) showed its concern for the public good in a number of ways. From the earliest of times it provided free health care to all of its citizens — rich and poor alike.”
The book goes on to say that there was a salaried city doctor who was required to treat all who came to him without charge, and that this system of universal care was particularly important during the plague of the 14th Century, which killed a third of the Republic’s inhabitants.
Of course it could probably be argued that given the state of medical knowledge in the 14th Century (leeches, anyone?) the citizenry might have been better off without universal health care, but that’s a minor quibble. The key point is that more than seven centuries ago, it was regarded, at least in Dubrovnik, as a civil right. How strange that the idea has never gained such traction in America, and that we’re still fighting over it today.
This week the New York Times carried an online opinion piece http://nyti.ms/MVfgr7 by Tina Rosenberg about universal health care in Rwanda. It seems that once the country stabilized after the genocide of 1994, that was one of the first orders of business for the new regime.
Rwanda has now established a system of near-universal care that is widely used and has done wonders for its people. It is paid for by a modest tax on the population, and when the government determined, a few years ago, that even the modest tax was too much for many citizens, it raised the health money by quadrupling taxes on higher earners. Apparently the country has no equivalent of Fox News to raise the alarm of class warfare.
Citizens are required to make a co-payment of about 33 cents in American money when they go in for treatment. In a country where the average annual income is about $550, that’s about the equivalent of a $40 co-pay for an average American family. As the Republicans would say, it gives people some skin in the game and discourages frivolous use of health services.
It’s Hard to Argue With Results
Even with the co-pay, use of health care services is up dramatically in Rwanda, and so are the health benefits. Seventy percent of births now occur at a health care facility, which has dramatically cut the mortality rate for both infants and mothers. In just the past decade the average life expectancy in the country has increased by 10 years, from 48 to 58.
It works. But then we’ve known that all along from the examples of England, Germany, Sweden, France, Canada, Japan — in fact, just about the entire industrialized world except for the United States. In America, health care is the best in the world for those who have good insurance; in the countries cited, it’s a hair less good, but still very good, for everybody. That’s why the United States ranks lower than many other advanced nations in overall health outcomes.
To be sure, advances in medical technology are putting a strain on health budgets, and the issue must be addressed. But unless we get four consecutive Republican presidents, hospitals aren’t going to be able to throw patients out if they can’t pay, and as long as everyone has to be treated, the first step toward fiscal sanity is ensuring that everyone is covered. They knew that in Dubrovnik 700 years ago; why are we so slow to get it?