For starters, are we talking government as the single payer too? It’s an important distinction.

Personally, I’m not yet sold. On its surface universal healthcare does feel good to say, I’ll admit. Let’s treat everyone with kindness regardless of their wealth, age, race, sex, abilities, health, etc. But after that, I get stuck in the weeds.

I still struggle even to define both words. Does “universal” imply everyone’s covered for all their medical wants/needs? If so, then I’m out already. Every shift that I work I meet people who want tests and treatments that are not in their best interests.

For patients who ask about their bills, they’re a little easier to dissuade. But for those on someone else’s dime, the conversations can be exasperating. “My child has a fever and I just want to get some blood tests.” “I twisted my ankle and really just want an Xray to see if it’s broken.” “Jimmy came home acting weird and I want to get him drug tested.” “Can I get an MRI, a neurosurgical referral, and a Norco refill? My back keeps bothering me.”

We do our best in medicine to try to lay out the risks/benefits of any tests and treatments. But if you have a system where someone else is paying, and doctors (in some places) are paid to order more tests, and patients are handed satisfaction surveys, it’s not hard to see how the tab could explode with universal coverage.

Plus, that perspective above comes from the ER/urgent care side. On the other extreme, there is end of life care. How much is too much? How far does “universal” extend? I remember in medical school watching a “code” where a patient was trying his absolute best to die. I recall the resident who was a religious zealot of some sort telling me that “every moment of life is precious.” So compressions continued and medications flowed far longer than anyone would ever want. I feel metaphysical certitude those moments weren’t precious.

That resident was clearly not paying the bill, nor even considering what the bill could be. They say “the most expensive thing in medicine is the doctor’s pen,” though that’s a bit dated now since electronic medical records. Continuing along our current path, I predict some day our EMRs will be able to monetize every chest compression. The disconnect between prices and physicians is one of the biggest problems with our current system, and I can only see that worsening with “universal.”

Now if that word could be refined as “universal coverage for vaccines, tubals, vasectomies and addiction rehab,” then I’d be much more intrigued. I’d rather we choose a number of bang for buck services to cover universally and do them really well. Instead, today our government insurance systems cover based on age, income, race and occupation.

And how about the word “healthcare”? Please define. It’s an umbrella that covers earaches, Botox, depression, acne, electroshock therapy, erectile dysfunction, cancer, heart disease, femur fractures and a whole lot more. Cover all of it? If someone would draw me some lines I’d get a lot more interested.

Regarding the countries from this article,The 16 countries with the world’s best healthcare systems, it’s always tempting to study greener grass elsewhere. I’ve worked in Australia and New Zealand, and there were definitely some perks, though neither of these were true single payer universal healthcare. Both Aus and NZ had private insurance options. I’ve yet to experience a place with single payer universal. Does Qatar cover all of their immigrant workers who have built such a shining oasis? Any Canadians here want to weigh in? Please straighten me out. I’m not an expert on other country systems by any means.

Also, to me the question is not only “is universal healthcare superior?” Compared to what we have now, it probably is. But is that actually the best place to point the ship? Even if so, how would we get there? Who has to lose their jobs, and which companies have to shut their doors to make the switch?

I’ll admit that I think of many social topics the way that I think about construction. If you go to the electrical section of Home Depot, you can find junction boxes labelled “old build” or “new build.” If the US were a “new build” clean slate with a functional Congress and a unified, cohesive, relatively healthy population, perhaps I’d feel a little more comfortable with the idea of universal healthcare. But we don’t. We have a fixer-upper duplex apartment building where the tenants of each side don’t talk, and leadership from the landlord comes in Tweets.

Plus we have a remarkably needy population today. We’ve spent decades getting thousands of people addicted to narcotics, and now we’re overdose leaders. And find me a US city with no homeless population. Even in “happiest” SLO I find the numbers staggering. Their medical needs in the US are extreme.

We have students nearing high school graduation today who have never known the country at peace, and returning veterans with amputations of the body and mind. PTSD is very real for many and its ripples will extend through generations. How about the parents of lost soldiers and their psychiatric needs? How about aging baby boomers? How about healthcare for the kids getting left behind by parents escorted back to Mexico? I’m seeing these kids already.

Also, on the tech side, we have the buildings and the gear all ready and waiting for the masses to arrive. I remember in medical school they said we had more MRIs in St. Louis than there were in Canada. In 2015 there were roughly 2380 PET scan sites in the US. If you build it (which we have) and cover it all, patients will most definitely come.

So for universal healthcare, I still tread lightly and prefer incrementalism… OTC Zofran for starters. Does that make me conservative, a skeptic or just old?