This week, Dr. Robert Blake, emeritus professor of Family and Community Medicine at the University of Missouri, remembered a patient who died, but possibly could have lived a longer life.
"He was a farmer and had high blood pressure," Blake said.
The farmer had an insurance policy with a high deductible, and because of that, couldn't afford to do a lot.
"It was a huge barrier to him getting health care," Blake said.
The doctor said he helped him as much as possible with cheaper medication and good advice, but if he'd had access to more expensive treatment, his story might have ended another way.
"He had a disabling stroke and died soon after," he added of the patient.
Blake brought his understanding of challenges to health care in rural communities to a gathering Monday at KACO the Kitchen. This informal discussion was hosted by Callaway County Concerned Citizens, a local group that discusses issues in Callaway County.
"I'm old enough to remember the old hospital on Jefferson Street," group leader Margot McMillen said.
That facilities lacked in technology, and so the Fulton community decided to build another.
"The community got together to buy land and build the hospital on Hospital Drive," she said. "Nowadays, we don't know what the future of that hospital will be."
CCCC started meeting about a year and a half ago to look at issues including education, environment and health care. They've also discussed alternative energy, a community health ordinance to do with confined animal feeding operations and voter line redistricting.
"We meet on the fourth Monday of every month at KACO," McMillen said.
In line with concerns about rising costs of health care and lack of access and affordability, CCCC members invited Blake to talk about a national health care system, including a Medicare-for-all option. For decades, he has been a member of a national organization, Physicians for a National Health Program, comprising health professionals and others who advocate for universal health care in the United States. Blake is also a member of the recently organized Columbia chapter of Physicians for a National Health Program (pnhp.org/states/missouri).
In 1971, Sen. Ed Kennedy began advocating for a national health care system in the United States. In 2009, before his death, he wrote in Newsweek magazine: "Every American should be able to get the same treatment that U.S. senators are entitled to. This is the cause of my life."
Blake finds the state of health care in the U.S. in need of a major overhaul, he said.
He added that health is, "A state of complete physical, mental and social well-being — not just the absence of disease."
Health is vital to quality of life, Blake said.
"Health enables you to do what you want to do," he added.
Blake said and others back up the fact Americans spend more on health care per capita than any other country in the world.
"We spent $3.5 trillion on health care, and it's 18 percent of the GDP (gross domestic product) of our economy. It costs about $10,000 per person — two times as much as any other country for an individual person," he said.
That $3.5 trillion is about one-sixth of the U.S. economy. Despite the high price tag, the U.S. remains the only wealthy, developed nation without universal health coverage.
"We should have the best health care system in the world, but in fact, that's far from the case," Blake said.
"Look at the longevity rates, the mortality rates. We have shorter life spans and higher infant mortality," than countries with universal health care, he said. "Women are more likely to die from pregnancy complications than women in 45 other countries."
Blake cited one example of a common disease.
"People with cystic fibrosis in Canada live 10 years longer than in the United States," he said. "It's the same disease. It's the same treatments."
There are several different kinds of health care systems being managed around the world.
"Canada pays for insurance for everybody," Blake said. "Taiwan and Australia and Sweden do it in somewhat different ways."
The United Kingdom used the National Health Service, single-payer model, tax funded with most health care provided through public hospitals and clinic. In the U.S., the U.S. Department of Veterans Affairs operates similarly.
National Health Insurance is a model in which the government mandates everyone have health insurance delivered through a mix of public, nonprofit and for-profit providers.
The U.S. Medicare system is also a single-payer model where everyone is required to pay into a government insurance plan, which in turn pays doctors and hospitals. While Medicare serves citizens age 65 and older, some are calling for reformation including all citizens in this program.
Blake said, before the Affordable Care Act, 50 million Americans — 17 percent of the population — had no health insurance. Another 50 million were under-insured.
"They didn't have what they needed," he said. "And 44,000 Americans die every year because of the lack of health insurance. Imagine the reaction if 44,000 Americans were killed by terrorists. It would be a different reaction."
When the ACA was enacted, the 17 percent dropped to 9 percent, but in states like Missouri that didn't expand Medicaid programs to its residents, the number dropped to just 12 percent.
"I think there is a better solution," Blake added. "We have the resources. We should be able to do this. Other countries are able to do this."
Opening Medicare to everyone is a popular option, "And it's also effective," Blake said.
He said health improves for older Americans once they are eligible for Medicare.
"At age 65, the mortality in the United States begins to improve, and it's progressive," he added. "Medicare covers these people, and this is incredibly powerful evidence."
Administrative costs for Medicare are 3 percent, with the rest of the money collected going to patient care. For Medicaid, it's 5 percent. However, for insurance companies, it's more like 20-30 percent. The ACA required 80-85 percent of funds raised go to patient care.
"It forced insurance companies to spend more on patients, and so they pulled out of the exchanges," Blake added.
People with no insurance — often the poorest and most at risk — are charged the highest rates.
"With a single-payer system, you get rid of all that," Blake said.
If all Americans are paying into that system, it will support a big pool of money for those who need it the most.
For Blake, it comes down to one thing.
"There's the moral argument. Our fellow citizens deserve this," he said. "Health care to me is a fundamental human right. We're never going to provide a system that provides everybody with everything they want; we need professional to help them meet their needs. The number one reason we deserve this: To me, it's a moral imperative."