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One of the most difficult questions on healthcare our society will wrestle with is should all people get the same level of health benefits? With the rapid advances in medical technology, pharmaceuticals, bio-tech, and other high-technology procedures, we are experiencing a very rapid increase in health care costs. Will we be able to afford all those advanced technologies, drugs, and procedures for everyone?

This question has been answered in Canada and the answer is yes-we will all have the same level of benefits and if you want additional benefits you will have to leave the country. In the United Kingdom, everyone has the same level of benefits except for those who buy additional benefits with private insurance.

In the United States, we have ostensibly said yes by providing the same level of benefits in our Medicaid and Medicare programs as private insurance. However, we have quietly reduced access in the Medicaid arena by paying physicians significantly less than what Medicare and private insurance pay. As a result of these reduced payments to physicians, many of the top specialists do not participate in the Medicaid plans, thereby reducing access to high-tech services and procedures. In certain states, the Medicare programs mandate generic drugs where there is a brand substitute.

Until we decisively answer this question, state and federal budgets will continue to underfund Medicaid and the cost of these higher-tech procedures will continue to be borne by the private insurance marketplace. And as private insurance medical cost increases continue at the unsustainable double digits, the sooner we answer the question of whether Medicaid is going to have equal benefits to private insurance or not, the faster we can solve the current private insurance cost crisis.

This debate is happening right now as supporters of universal care and single payer systems are clearly in the camp of equal benefits for all. These supporters are also supporters of a national healthcare plan. People who oppose the national plan and universal health care implicity say there should be a different level of benefits going forward. Although one of the most difficult questions on our plates, we must answer it sooner than we think.

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