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For the Public Health by Gerald Ledlow, Ph.D. MHA, CHE
Providing primary care coverage to all Americans makes sense
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    I believe that primary healthcare ought to be considered a right of citizenship, a right that should be funded in a prudent fashion.  We can easily demonstrate that primary healthcare contributes to the overall productivity, safety, and compassion of a nation and thus, should be considered a public good.   
    Yet more than 48 million Americans — including many working, tax-paying Americans — live without the benefit of health insurance coverage. As a nation we face a basic value question: is primary healthcare is a right or a privilege?
    Primary care for all Americans is a public good, considering: a) infectious disease rates and infection transfer rates (worldwide, infectious disease is the second leading cause of lost years of work and death);  b) global travel and the relative ease of world-wide transmission of disease; c) the need for a clinical infrastructure that can deal effectively with  present and future bioterrorism threats, including immunizations, prophylaxis, detection and rapid response;  and d) society’s need to build our sense of compassion for each other. 
    America’s employers have seen health insurance costs skyrocket. Our companies spend more on healthcare, but offer fewer healthcare services to their employees. Life expectancy here is appreciably less than several other countries. Uncompensated illness or injury in the American workplace often results in a loss of productivity, thereby reducing our ability to compete in the global marketplace.
    Hospital emergency departments across the nation are in crisis because they carry the burden of uncompensated care for those without insurance, especially those uninsured with chronic diseases. Hospitals and physicians also bear the burden of uncompensated care; for example, Georgia hospitals spend more than $1.28 billion in indigent or uncompensated care each year.
    Given the problems resulting from lack of healthcare insurance, the natural question arises: Why not provide total healthcare insurance for the nation’s uninsured? The straightforward answer: Money and politics. A simple, conservative estimate of the tax increase needed to provide total healthcare coverage is $523 to $1,222 annually per person, a burden unacceptable to most Americans.  A primary care program is estimated to be a much lower, in the range of $125 to $522 per working American.
    Funding for a national primary health care system could be managed in a number of ways:
    - a donation-based program offering tax deductions for individuals and businesses;
    - a collaborative hospital-physician partnership that would subsidize physicians for reducing uncompensated care burden on hospitals;
    - an increase in “sin taxes” (tobacco, alcohol, gambling);
    - a federal block grant to states; and
    - a general income tax increase.
    The U.S. government has grappled with the dilemma of the uninsured many times over the last several decades, most notably in 1993 when a national consensus developed that universal health coverage was too much, too fast, and too expensive. Today, the U.S. needs a fresh perspective and a practical, incremental model for delivering primary health care to all Americans.  Starting with universal primary care coverage makes sense.

    Dr. Gerald Ledlow is an associate professor of Health Services Policy and Management in the Jiann-Ping Hsu College of Public Health at Georgia Southern University. He is board-certified in healthcare administration from the American College of Healthcare Executives and is the author and editor of several books, including "Optimize Your Healthcare Supply Chain Performance: A Strategic Approach" (Health Administration Press, 2007).
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