Comprehensive Benefits

Another important measure of health care systems is whether they offer all of the essential services individuals need. The difficulty lies in defining what is essential. Although all observers would agree that comprehensive health care must include coverage for primary care, agreement breaks down quickly when we begin discussing specialty care. Some individuals, for example, consider coronary bypass surgery an essential service, but others consider it an overpriced and overhyped luxury. Similarly, some people favor offering only procedures necessary to keep patients alive, but others support offer- ing procedures or technologies such as hip-replacement surgery, home health care, hearing aids, or dental care, which improve quality of life but don’t extend life.

Any system that does not provide comprehensive benefits runs the risk of devolving into a two-class system in which some individuals can buy more care than others can. To those who believe health care is a human right, such a system seems unethical. Others object to such systems on economic grounds, arguing that it costs less in the long run to plan on providing care for everyone than to hap- hazardly shift costs to the general public when individuals who can’t afford care eventually seek care anyway.