Nothing is ever done until everyone is convinced that it ought to be done, and has been convinced for so long that it is now time to do something else. — F.M. Cornford
There are no simple solutions to complex problems — unless they’ve become so complex that only a simple solution will do. Welcome to health care and insurance in all of their complexity.
Engineers like to say that if a new machine of structure has too many parts, it’s not ready. Not a bad idea to keep in mind when creating a societal structure like health care. One should know where one wants to go; knowing what one doesn’t want isn’t a starting point.
I submit that the goal of health policy, stripped of its advocates, denigrators and rentiers, should be to get everyone insured for the minimum amount of money and best care result. Simple, eh?
Some aspects:
- There ought to be enough money for the United States to have universal health care, not a patchwork — a crazy quilt with holes and weak seams. We spend 19 percent of our GDP on health care, but Germany and the Netherlands spend just under 12 percent of theirs on hybrid public/private, comprehensive systems.
- Insurance is a probability game, ergo it’s not unreasonable to ask the able-bodied to pay for the sick.
- Mandates are not alien to us. We are mandated to pay taxes, drive with licenses and even wear clothes.
- The more people covered by insurance, the lower the cost to all.
- There seems to be no good explanation in the public record as to why medicine is so expensive in the United States — so much more expensive than elsewhere on earth, under wildly different systems.
- The United States is the only country that leans on employers to provide health insurance to employees and to administer the policy and deal with issues that arrive with disputes.
- The cost of the service patients receive is opaque once a third-party payer is responsible: the insurer. The basis of a hospital charge is hidden from the patients and policymakers. The patient has little idea what a procedure costs and who benefits from the expenditure, including doctors who own imaging companies, testing labs and even operating theaters. At the time of delivery, as Norman Macrae noted in The Economist years ago, neither the doctor nor the patients has an interest in the cost.
- Hospitals are burdened with emergency rooms that can’t refuse the uninsured and hide this cost by overcharging elsewhere.
For more than 30 years I operated a publishing business and provided health care for my employees. It cost. It cost in time. It cost in premiums. It cost in employee well-being because as the premiums (well before Obamacare) rose by 15 percent to 25 percent, I was forced to shop for providers — which meant, in many cases, new doctors for my employees every year.
After salaries, health care was the big expenditure. I thought I was in the publishing business, but I was also, reluctantly, in the health care business.
I was keen that people have the security that goes with not having to be frightened of getting sick or falling off a bicycle. Some of my employees were on a spouse’s policy as well as mine and didn’t tell me. One man, a printer, said he didn’t like to fill in forms, so he, his wife and three children just told the hospital emergency room that the family had no money. He wanted me to give him what I was paying the insurer so he could spend it.
None of the proposals now before Congress, nor those codified in Obamacare, address the fact that as a nation we backed into health care and created complex set of stakeholders — some of whom should leave the field.
For someone who has wrestled with health care as a provider, as in other things, I believe that if the purpose is not defined, you’ll get the wrong result no matter how hard you try.
The big questions Congress should be asking of the House Republican health care plan, backed by President Donald Trump, are: Will it save money? Will everyone be covered adequately? From my point of view, Congress is proposing to replace a monster with a monstrosity.
That’s no prescription for a healthy nation, free from fear of accident or illness. Time to grab a clean sheet of paper and start again, maybe check on what works around the world, if that isn’t too damaging to our self-esteem.