EDITOR’S NOTE: This column is the first of two parts by Justin Coby, executive director of Health Partners Free Clinic

As the national debate about healthcare delivery continues in this country, I would like to take a moment to step back and take a look at the issue from a more global perspective. However, in this case, perhaps the most “global” insights come best from our local communities. Is the question here that all deserve access to quality healthcare or health insurance? Unfortunately, we have married the two together in highly publicized political debate that we forget that these are two entirely separate institutions.

The case for health insurance

Winston Churchill was known for his many quips and ever-changing view of the role that the State should play in the provision of care for its people. Once a radical supporter of a social insurance plan for Great Britain, he had gone on to fight against the undaunted growth of socialism for years after his “darkest hours” as Prime Minister. Though he felt strongly that there was need for a welfare state, he also struggled with the idea of the state’s inevitable ownership of its people in an unchecked socialist model.

What does the “British Bulldog” have to do with health insurance in America? The point here is exactly the issue at hand. If we are discussing a sweeping policy, like a national insurance regulated by the state, then we need to look to decisions made in our past in order to proclaim knowledge for the future. Even though Churchill, a man so beloved by his “island” that he was once offered the title of Duke, was known for his clear decisions he still battled with a concept that inevitably lead to the socialism of healthcare in Britain with the enactment of the National Insurance Act of 1946. This then instituted a state health service, effective in 1948. The Act provided for compulsory contributions for unemployment, sickness, maternity and widows’ benefits and old age pensions from employers and employees, with the government funding the balance.

I have to say, among all of the debates about healthcare over the past eight years, I am surprised that Churchill’s name doesn’t come up. He left his position of Prime Minister in 1945 to be replaced by Clement Attlee, but he still continued to make his arguments against the spread of socialist ideology. Remember though, at one time he had been radically for this type of social insurance.

This background brings us to the discussion of the health insurance in our communities. A point of clarity, health insurance IS important and should be affordably available to every citizen. Anyone of us could have a dear family member struck by a car, face a cancer diagnosis, or have a stroke. God forbid, but none of us are outside the grasp of these life altering events. So let’s just put that debate to bed. Now, the question I have is, are we utilizing that insurance most appropriately?

The horrible turns of fate that I mentioned above could potentially run an individual upwards of 10’s to 100’s of thousands of dollars in healthcare expenses without insurance. Obviously, this would not be possible for the majority of folks in our community. We must have an insurance policy to cover these situations. However, when we look at healthcare costs, this is not the majority of billable services that occur. Chronic care disease management (i.e. diabetes, heart disease, COPD, etc.) make up most of the pie when looking at healthcare costs in our community and across the nation.

Note here, the word management and not cure is used. These disease states are currently treated across years of time, with more medically invasive procedures as a possibility along the way. In this scenario, we have become more heavily reliant on the insurance to steer the direction of our health than our health to dictate necessity for insurance.

So, back to the question, are we utilizing our insurance appropriately? Are we as citizens asking for available healthcare to insure a certain quality of life or just longevity? Has our desire to have insurance for all outweighed the desire to have healthcare for all? Pondering these questions may leave you, as they have I, wondering what opportunities exist to improve our healthcare delivery systems.

COMING UP: The case for healthcare