By Najib Aminy

When Judit Castello came to Stony Brook University as a visiting researcher, she had done her studying. Only, it wasn’t for any related coursework that Castello studied. It was the United States healthcare system that she looked into before leaving from her native country of Spain.


Judit Castello

“I was never worried about these things because I know the other European countries have universal healthcare,” said Castello, a 30-year-old PhD student who attends Maastricht University in the Netherlands. “But here, even if I am covered and everything is fine, I still have to know who is my insurer, what I have to do, that was kind of difficult to get into this healthcare world.”

For Castello, who is nearing the completion of her research on services to help the disabled in find jobs, the United States’ system of healthcare may seem foreign, but even to Americans, the current debate of health care reform is just as puzzling. In a recent 60 Minutes and Vanity Fair poll, roughly 70 percent of Americans polled could not explain what the “public option” was.

Part of the reason why the debate over healthcare reform is so complex is because of varying interests, comparisons to international systems, and differing policies within the reform currently on the Senate table. While the current reform is puzzling, the debate is nothing new.


Since the administration of President Harry Truman, health care reform has been brought up time and time again. Because of the business and political interests that come along with healthcare, any true reform has been limited at best, says Dr. Charles Robbins, Associate Dean of the School of Social Welfare at Stony Brook University.

“Healthcare is big business. Healthcare is money. It is the largest sector of our gross national product,” Robbins said. “There’s an incredible pressure on elected officials to maintain the status quo, to tweak it a little bit, to make people believe that you are changing something, but not changing it fundamentally.”

The Washington Post reported that the insurance industry has spent roughly $1.4 million a day attemptong to influence the outcome of healthcare reform. This, according to Robbins, is just one part of the problem.

The other falls in line with a cultural belief to keep that government should stay away from business. “People don’t want to be told what to do, they don’t want anyone getting in their business,” Robbins said. With healthcare reform, Robbins says that many Americans fear that the government will get in the way of their health and their doctor, but that they fail to realize the involvement of these insurance companies in the same scenario.

“Neither you or your doctor can do anything without the approval of insurance companies,” Robbins said. “We are naïve to believe that insurance companies are this benevolent organization looking out for our own good. They are looking for their own profit and their own shareholders.”

Ultimately, what Robbins argues that is the current system of health care, which is driven by market forces, is not working. The profits of one company will determine who gets what coverage, what rates are offered, and most of all, the affordability.


At the core of this reform lies policy, a term that Dr. Sabatini Dwyer, chair of healthcare policy and management at the School of Health Technology and Management, says is both overlooked and ignored. Policy, as Dwyer defined during a healthcare seminar for students, is the deliberate plan to guide decisions to achieve a rational outcome. This simple definition, Dwyer says, goes a long way into understanding the core of the healthcare debate.

According to this definition, rational outcomes, as Dwyer discussed in her lecture, was to be determined by society through, in America’s case, elected representation. At the end of this all, the point Dwyer emphasized was that behind every policy is a clear objective, and in the case of healthcare reform, is to lower costs. This comes after the fact that since 2000, premiums have increased at a rate faster than before, while health expenditures have increased faster than the rate of inflation since the 1960s, according to Dwyer.

“It really takes people to feel the pain before they realize they need change,” said Dwyer, a former senior economist in the Social Security Administration. “The culture is that we only embrace government intervention when we realize we need them.”

Because healthcare is market based, in that the majority of care providers are through private insurance companies, much of the availability and efficiency is determined by profits. If insurers find that they are taking too many demanding high risk patients premiums for the average, healthy American would increase to maintain a profit.

But in the past, there have been times where the government set up programs to help deal with the higher risk patients and work towards increasing availability, easing the burden from the private sector and providing care to those in need. The implementation of programs such as Medicare, which provides funding to those 65 and over as well as residency training; Medicaid, government funding for low-income households; and employer tax incentives have been key components of what Robbins calls socialized health care.

But when arguments against reform are brought forth, such as, that the government is seeking to have full control over healthcare, Robbins says that these are inaccurate and misguided.

“These are scare tactics going back to the Clinton reform, the reality is what they are describing is what the Medicare program is or Veteran Assistant programs,” Robbins said. “To call the health reform socialism wouldn’t make sense.”


Roughly one month ago, the House had passed their version of the health care bill, 220 to 215 votes. All but one republican had voted against the legislation while 39 democrats had voted against the bill.

Currently, there are revisions being discussed to H.R. 3962. Initially, a “single-payer” system was thrown around in the beginning of the summer. However, that has now been reduced to a public option that critics now say has been watered down.

“The public option is for people have no other way of getting insurance,” Robbins said. “Whether they can’t afford it, don’t qualify for Medicaid, or have a condition that would have them paying high expenses at a private insurer, it’s a pool of last resort.”

This would free up, according to Robbins, the demanding patients that were once covered by the private insurance companies resulting in profits for these insurance companies. “Initially, the public option was to be done in a manner that was cheaper than the insurance companies,” said Robbins, who was involved with the Clinton healthcare reform of the early 1990s. “But if your people are high demand, to run it at a cheaper cost is highly unlikely and just about impossible.”

Dwyer suspects that, given the public option, those who are currently insured, either independently or through their employer, will likely remain unaffected if the health reform were to pass. “The way the law is written, large employers are discouraged to participate in the public option,” Dwyer said.

The Senate is currently debating whether to drop the public option and replace it with a government monitored, private-run, non-profit system.


Having experienced a universal healthcare system in Spain, Castello, who also has private insurance, finds it confusing that people would be against a universal system.

“I cannot possibly understand why people would be against having a public sector. Some people want it private, fine, sure why not? Why should it prohibit someone from having public insurance?” Castello asked. “I am also willing to pay taxes so someone, not as fortunate as me, can have access to health care.”

Stony Brook junior Aditya Ramanathan believes, having a government-run healthcare option would severely limit insurance companies, and is a misguided attempt at true reform.

“The public option won’t make the healthcare costs go away,” said Ramanathan, a member of the Stony Brook College Republicans. “The idea is that we want to make insurance affordable, to have a balance of private and public,” Ramanathan said. “We are not doing that by increasing the tax on Cadillac [high premium] healthcare plans. These taxes increase cost on private insurance.”

Ramanathan argues that with the increase of this tax, private insurers will be looking to charge more, become less likely to cover high risk patients, and have employers drop from private coverage to a public-run option.

“The public option is not just going to cover 40 million uninsured,” said Ramanathan, a Biochemistry major. “It will be covering a lot more high risk patients and be a lot more expensive than imagined.”

The alternative to taxes on the higher-priced plans would be to open competition rather than restrict business with taxes. Private insurance companies, for the most part, operate at a state level. They are faced with competition only in that region or state. This competition does not cross over state borders and allows companies to essentially run premiums with less competition.

Ramanathan argues that, by opening competition and freeing up the market, the system of health care wouldn’t need the giant overhaul that is being proposed, and prices would lower due to the increased competitiveness among companies.

“We want the model of what’s going on in France. We want the plans at the top of the list. We are not choosing that,” Ramanathan said. “It’s misguided to think we are going towards a European model. We are going towards a very strange, different, absolutely catastrophic model, as far as I see it.”


The question that remains unanswered is how the American populous views healthcare. Is it a right or a commodity? Other issues that factor into this debate also range from the cultural aspects of health in America. Should there be an increased focus on preventative care to avoid chronic diseases and illnesses? As of now, the support and opposition amongst the American people for health care reform is roughly the same. Some are worried by the price it may cost the country.

Independent research by the Congressional Budget Office done in early October found that the Senate healthcare bill, at the time, would cost roughly $850 billion over 10 years and cut the federal deficit by $81 billion, all while expanding those who are insured in America to 94 percent.

It remains unclear as to what will happen with the House version of the health care reform bill and what the Senate will do.

As for Castello, who will return to the Netherlands to continue her studies, the differences of healthcare between the United States and Europe were part of her educational experience at Stony Brook.

“Its very interesting to see how all these different systems work,” Castello said. “I think it’s all due to culture.”