On Health Care
Over the last several years, the political discourse on the health care system in the United States has been loud and with good reason. It’s one of the few areas where both Democrats and Republicans generally agree; the system is fundamentally broken and needs to be fixed. Where they part of course is in how to fix it. It is in this sphere of argument where the rhetoric is needlessly hyperbolic and sadly recalcitrant.
The recent passage of the Democrats’ reform bill only escalated the hyperbole. Both sides claim its historic importance. The Democrats call it an achievement on par with civil rights legislation in the Sixties; the Republicans shout “socialism” and the death of the American Way. Neither perspective is accurate. At best, the bill is a step in the right direction toward necessary and more meaningful reform down the road. At worst, it doubles-down on a system that is inherently and disastrously flawed. The reality is that both of those scenarios are likely true. I think one can only hope that the reform package makes things incrementally better - working within the current system to provide close to universal coverage and allow people with pre-existing conditions to purchase health insurance.
Unfortunately what the new bill does not do is address some of the more fundamental problems of our Frankenbeast of a health care system. It only nips at the edges. On this score, I still contend that David Goldhill’s article - How American Health Care Killed My Father - from last September’s The Atlantic is the finest essay on the subject of health care and identifies in the clearest and simplest terms the failings of our public-private hybrid system. Whatever your position - whether you prefer a government “single payer” solution or a completely free market approach - the article lays all the issues on the table succinctly, in terms anyone can understand.
While the title is needlessly provocative (the article really has very little to do with his father’s death), its thesis shouldn’t be. The system is a mess, and on this we can all agree. The question is why.
He lays out some of the basic problems:
- When we talk about health care in this country, we almost universally mean health insurance, which are, of course, two distinct things. But in the current regime, they’re inextricably linked.
- Employer-based programs (incentivized by tax subsidies) depress wages and eliminate choice, demanding that some get more health insurance than they want (or need) and others get less and all are paid in salary less than they would be otherwise.
- The current system obscures costs and pushes more care, whether it’s necessary or not. If you aren’t “paying” for it, why not more?
- And lastly and perhaps most importantly consumers are not primarily at the center of the health care system. We are bystanders in a bureaucratic game between doctors, insurance companies, and government agencies.
The new reform bill does nothing to address any of these problems, and in some cases exacerbates the problem. I do believe it’s a step in the right direction. After all, you have to start somewhere. Doing nothing is simply not an option. But until we address these basic flaws of our health care apparatus, the system will continue to break down. I am optimistic that this first reform opens the door for many more down the road and sets the stage for exchanges to replace employer-based programs, more choice for consumers, and so on. But I think we’re deluding ourselves if we claim because nearly all are now insured that the system is fixed. And we’re equally foolish to decry that specter of communism looms. What needs to happen now is the hard work of building on the best aspects of the reform while removing the cancers that swell costs, hamper care, and fail to actually promote health.
