Is health care a privilege or a right? What are the main causes for the high cost of care in the United States, and what should be done to fix the system?

A panel of five Cornell and Ithaca experts on various sides of the health care debate discussed such questions Nov. 17 in Goldwin Smith Hall's Hollis E. Cornell Auditorium.

According to news reports, 15 percent of Americans -- some 50 million people -- are uninsured. Meanwhile, the quality of care provided to the insured is often lacking, said moderator Edgar Sarmiento '10, a member of Alphi Phi Alpha Fraternity, which hosted the debate. While America spends the most per capita on health care, he said, the United States ranks 37th in the world in health care performance and 72nd in overall health, according to the World Health Organization.

The U.S. House of Representatives passed a health care reform bill Nov. 7; and Senate Majority Leader Harry Reid (D-Nev.) presented a similar bill to the Senate for debate Nov. 18.

Panelist Bethany Schroder, president of the Ithaca Health Alliance Free Clinic, emphasized the human cost of the health care crisis. "There are 13,000 uninsured in [Tompkins] County; most of them make too much for Medicaid but too little to buy coverage," she said.

William Baldwin '10 of the Cornell Democrats discussed the plight of the underinsured, mentioning a young amputee who was recently denied further coverage because he had received the maximum coverage allowed in his plan. He also criticized insurance companies' practice of denying coverage to patients with pre-existing conditions, calling the practice a "moral evil."

But panelist Sinan Ünür, Ph.D. '99, co-founder of Cornell's Freedom and Free Societies program, disagreed, arguing that the concept of insurance is frequently misapplied in the health care debate.

"You cannot buy fire insurance after your house has burnt down, and so you can't buy health insurance after you are sick," he said. "It violates the insurance market."

He suggested that the market could provide its own solutions if health insurance could be purchased across state lines.

Panelist Jud Kilgore, a physician at the Ithaca Free Clinic, said that much of the increase in medical costs could be attributed to expensive new technologies.

The American health care system is set up in a way that incurs high costs, said panelist Sean Nicholson, associate professor of policy analysis and management, because patients pay per service, and doctors and hospitals often order extra tests to pay for expensive technology.

But Nicholson added that the country's current problems "are not about cost, but waste. … What we really want to do is reduce the waste, not the number of MRIs."

Panelist John Kuder, associate professor of health administration, was optimistic about legislative reform. Even if the health care bill is diluted before it is passed by the Senate, he said, the reforms that survive are likely to be sufficient.

Ray Mensah '11, a member of the College Republicans, disagreed. A public option would create a "dangerous level" of government control in private life, he said.

And the consequences could be dire, said Ünür, who warned that Americans would overuse health care services if they were subsidized by the federal government. Describing government mismanagement in other countries, he said, "Americans think that it can't happen here, but the U.S. could become Zimbabwe, where everything is scarce."

Jordan Walters '11 is a writer intern for the Cornell Chronicle.