Mexico Shows Us the Way

In a New York Times op-ed published on April 5, David de Ferranti, former vice president of the World Bank, and Julio Frenck, former minister of health in Mexico wrote “This week, at an international forum in Mexico City, country delegates from around the globe made clear that they are not only aiming for universal coverage but also rapidly getting there.”

They go on to say, “Except for the United States, the 25 wealthiest nations now have some form of it. Others are not far behind, including Brazil and Thailand. Even nations at lower income levels, such as the Philippines, Vietnam, Rwanda, and Ghana are working toward it. India, South Africa, China, and Colombia are on the move, too.”

Evidently, Mexico, with an economy one tenth the size of ours, drug-related violence common, and a skeptical populace, has managed to achieve what the U.S. can’t—true health care reform and universal care for its citizens.

Resistance from special interest groups was no less fierce than it has been and will be here and most Mexicans didn’t believe any solution would help. So what did they do? The reformers provided evidence, NOT spin, sometimes even pilot-testing their proposed changes. And they realized that expansion of coverage would have to be combined with a new way of paying providers that ended fee-for-service payment, as well as an emphasis on prevention to help avert costs of illnesses that can be prevented or managed well. If expansion occurred without the other two factors, the cost would be too high. Similar to the treatment of HIV, the combination of approaches is what works – you can’t manage the diseases if you only take the PI without the two NRTIs.

No matter what the Supreme Court decides in June, it is clear that the expansion of coverage the ACA has provided to children under age 26 who can remain on their parents’ policy, the coverage of children with pre-existing conditions (when their parents can find a company that sells kids’ insurance and then pay the exorbitant premiums), not to mention the fantasy of the 2014 Medicaid expansion, must be balanced with financial “NRTIs” – fees must be based on outcome, not number of tests, procedures, and treatments, and prevention must be a priority.

As these authors said, “Still another lesson is that one size definitely does not fit all. A country’s culture and politics matter. Take, for instance, the roles of government and the private sector. The fears some Americans have about big government are not borne out by results in other countries, where the private sector continues to have a vibrant role, especially in the provision of services, while the government concentrates more on financing, stewardship of the whole system and ensuring a level playing field.”

I have always maintained that Americans are capable of learning from what other countries are doing and making it “our own.” But in order to do that, we must have as many voices as possible demanding that level playing field as loudly as possible. We know what the Right will do—as soon as that ruling exits the Supreme Court’s doors, a firestorm of alarmist, “big government,” 99%-hating spin will be issued to ensure that seniors see single-payer as the arbiter of euthanasia, that “average” people see it as taking money from their pockets to pay for the health care of lazy, sinful, irresponsible poor people who refuse to get a job, that once again the self-righteous wailing about abortion funding will replay, and President Obama will be called a communist. And not one idea will come from them about how to fix the system if not through single-payer.

That’s why we have to be there to firmly grab the microphones and tape recorders and tell the truth. That’s why we can’t just sit and wait to see what happens, hoping against all evidence to the contrary that the ACA will survive and be implemented without further challenge. That’s why our army must be gathered, the original ACT UP activism resurrected and re-energized and taught to millions of people who aren’t HIV-positive, who know nothing about its success. That’s why we must all remember that 250,000 people hitchhiked, rode in cars and pick-up trucks, and took busses, trains, and planes to the National Mall in 1963 to demand basic human civil rights and won. They won. The Civil Rights Act was signed into law, just as the Medicare for All Act could be.

We can do it if we dare. We can do it if we overcome our doubts, our fears, our “what if”s. We can do it together. DUH.