Now that another election year approaches, proclamations by the candidates about grand and revolutionary changes are being made at every speech. One of the hottest topics discussed, with little definition typically provided, is that of health care reform. Everyone seems to agree the current US health care system is not working well, but is it a crisis in the making, or simply an intricate and complex network in need of some fine tuning? The clear consensus is something dramatic needs to be done.

The story is all-too common. Someone has a significant medical problem, care is required, yet even though they have private insurance, they end up with exorbitant bills. After high deductibles, co-insurance payments, and annual/lifetime limits, insurance benefits often simply run out. Insurance companies routinely deny claims or simply cancel someone’s insurance. Obviously, there are serious gaps in both the public and private health insurance programs in the United States, and these gaps limit access to health care. For example, and this is just one of many, neither private employment-related health insurance nor Medicare provides much coverage for long-term care.

We spend far more on health care than any other country does. According to the CDC, the cost of health care in the U.S. has grown to $3.2 trillion, which equates to approximately 17.8 percent of GDP. Experts seem to agree we are not getting a good value for our health care dollar. Indicators of health and wellness clearly demonstrate America is one of the least healthy countries, 33rd out of the 33 industrialized nations. There are many reasons for our steadily increasing health care expenditures, but it has proven to be challenging identifying the factors that contribute to our high and rising costs.

One candidate here is likely technology. New drugs, devices, and procedures are constantly becoming available, and they often cost significantly more than the technologies that they replace. New technologies permit the treatment of conditions that were previously untreatable.

New diagnostic technologies identify otherwise undetected medical conditions, which then must be treated. Sometimes new technologies permit continued functioning in the face of conditions that cannot be cured and previously could only be endured.

Many Americans feel it is time to institute a system of universal healthcare, in which every citizen has access to affordable coverage and care. The method of universal health care most often proposed these days is that of a single-payor system. All the industrialized nations of the world, there are 33 in total, have some version of universal health care, with the lone exception being the United States. One of the examples most often cited is that of our neighbors to the north.

Canadians have observed with a mix of fascination and horror the lies swirling in the U.S. media about their health care system. Numerous articles in U.S. media describe the horrors of the Canadian single payor system. A recent piece talks about a particular Canadian government-run health system that is so overburdened the typical patient waits 21.2 weeks for treatment from a specialist. Yet, Canadians interviewed for this article tell a different story, and genuinely feel they are receiving equitable, effective care. Some 96 percent of Canadians prefer their health care system to the U.S. model.

There are five underlying core principles guiding the Canadian approach to the provision of health care. Each provincial government must ensure the care provided is universal, accessible, comprehensive, portable, and publicly administered, at least if they are to receive federal funding. Canadians, in general, feel they have free choice and good access. Many studies bear this out, demonstrating the administration of health care in Canada does not add excessively to the cost, or complexity in the use of services. Nor does it exclude private-sector involvement.

How would the U.S. government pay for such a system? Many different proposals have been offered, but they all seem to include an increase in taxes. Politicians historically have avoided, at all costs, any proposal which requires this method of funding. It is true; most countries with some type of universal health care system do have higher taxes. But they also don’t have the premiums, the co-pays and deductibles, that are becoming ever-more burdensome to the citizens of the U.S.

American employers who provide health insurance are becoming uncommon. Private health insurance plans are increasingly transferring the cost of health care to their insureds through high cost-sharing obligations. Too many employed Americans simply cannot afford our health care, while those who are poorest, and often unemployable, qualify for government-run programs.

One of the many concerns with the single payor style of healthcare is the possibility there would be a significant reduction in physician’s wages. Despite this possibility, 56 percent of U.S. doctors are at least somewhat supportive of government-run healthcare. This support should be understandable when one has even a partial understanding of the obstacles and obfuscation present when attempting to provide quality health care in the U.S. Every insurer has different administrative requirements, covers different therapies at different levels, and reimburses on a different timeline. Medicare and Medicaid complicate matters further. Dealing with only one insurer, the government, sounds appealing.

How well can we compare the income of physicians, in general, who are part of these two constructs: single payor or private insurance? Detailed and accurate comparative physician income studies are lacking. When examining the income of Canadian physicians, it seems, indeed, they do generate less, but it is also true Canadian physicians have lower practice expenses. They are making less but are spending less to work. Some of the reasons for this include the lesser costs of billing, administration, and malpractice coverage.

The Canadian system is the inspiration for the recommendations of several presidential candidates. In it, the government provides health insurance for most medical needs, with no out-of-pocket costs. In place for over a quarter-century, public health insurance remains Canada’s most popular social program. But terms are being thrown about by numerous politicians, without clear definition, without regard for the specifics. We all know campaign promises are easy to make and impossible to keep.

If you were hoping for answers to the U.S. health care crisis in the space of this particular article, my apologies. Questions, certainly, since many even supposed experts have an abundance of those. But answers have been few, controversy plentiful, and a lack of definition on this topic likely to continue. Are we destined to be plagued by the provision of inadequate health care and its burden on the U.S. economy in the years to come? One important philosophical and very relevant question pertains to whether health care should be a right or a privilege. Should individuals, especially insurance company shareholders, be profiting from the sickness of others?

Campaign promises too-often prove to be mere rhetoric and produce little in the way of reform. The approaching election year has already seen this topic discussed numerous times by every possible candidate. Clearly, it is an issue important to all Americans, but those hoping for revolutionary changes in our system of health care provision may be disappointed. There are major players at work here, with billions of dollars passing through the hands of powerful people. That kind of power and wealth is not given up easily. Real change will be extraordinarily difficult, and may not be forthcoming, whether the American public wants it or not.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.