| It is true that many business leaders have not been excited about "universal" heath care proposals, but mostly because there is (i) real value in our current system that shouldn't be lost, and (ii) real concern about divorcing the issue of coverage from the issue of cost. Our current system presents huge cost problems that would be aggravated, certainly not resolved, by an expanded government role.
In looking at other countries, you also need to make apples-to-apples comparisons. Most other countries with government-run health care control costs by having the government own the system (the own the hospitals and clinics, and directly employ the doctors and nurses). They also ration high expense procedures, in preference to broader primary care. How many of these choices are we, as a society, really willing to make?
Let's take a minute to recognize the strengths of our system, look at it's primary shortcomings and outline some principles we can employ to make health care more affordable, efficient, and inclusive.
Strengths
Since World War II, and then with the advent of Medicare and Medicaid, the U.S. health care system has evolved into a blend of privately financed care--with employers playing a leading role--along with government support for the elderly and the poor. Under this mostly voluntary approach, we have managed to insure roughly 85% of our people, with emergency care legally required for everyone else. In fact the number of people with either private or government health insurance went up in 2006--to 249.8 million. More than 201 million are covered by private insurance, the vast majority of those--177 million--with employment-based coverage under a voluntary system with no employer mandates. Many of the insured, including all the elderly, enjoy comprehensive coverage. Medicare has recently added a prescription drug benefit that most seniors are very happy with.
The United States is home to the finest medical facilities, technologies, innovations, treatments, and human talent in the world. We have the home of medical innovation. Tens of billions of dollars in capital for medical and pharmaceutical R&D flows here every year. All these advances, along with the widespread availability of a vast range of medical services, have played a major role in enabling us to live longer and better lives.
Weaknesses
Costs. We pay more for health care than any other modern society. Yet on a national basis, we fall short on some key indices such as infant mortality and life expectancy. Costs are escalating with no end in sight--for businesses, families, and the government.
Medical Mistakes. Medical accidents are unacceptably high. An estimated 98,000 Americans die annually from preventable medical mistakes. According to the Institute of Medicine, medication errors harm at least 1.5 million people each year.
Medical Liability. Legal redress should be available for the victims of these mistakes, but that's no excuse for all the frivolous liability claims that are driving up prices and driving health care providers out of the profession.
Health IT. What other business still runs primarily on paper? Most health providers lack the IT systems necessary to coordinate a patient's care with other providers, share needed information, and monitor compliance with prevention and disease-management programs. This makes it impossible for doctors to provide the highest level of care and drives up costs by contributing to errors and redundant tests.
Consumer Responsibility. We need a far greater level of personal responsibility on the part of our citizens. Steve Burd is right - all of the biggest health problems in the United States are closely related to personal behavior. Consumers need to understand the impact of their health care decisions and the cost of their treatments. And, they need to take better care of themselves.
The Uninsured. There are 47 million people in this country without health care coverage, but that's only part of the story. In fact, nearly half of the 47 million uninsured remain so on average for just four months. In addition, if you subtract noncitizens, those making more than $75,000 who choose not to purchase insurance, and those who are eligible for government-provided care but don't take it, the number of long-term uninsured Americans is probably in the range of 10 to 15 million. That's still an unacceptably high number, but it's nowhere near 47 million.
So how do we build on the positive aspects of our health care system while addressing its significant shortcomings, and without implementing an expensive, inefficient government-run program that would take us in the wrong direction?
Five Principles
First, policymakers must adhere faithfully to the Hippocratic Oath--and that is, first do no harm! Some politicians seem intent on incrementally and systematically moving Americans out of private health care and into government programs. Would that really be better for most Americans?
Second, we should work to restore the viability of employer-sponsored health insurance, which covers more than 177 million Americans. In addition, Congress should pass Small Business Health Plans so that these companies can pool risk and purchase coverage at an affordable price.
Third, we need to revitalize the individual health care market. Congress can help greatly by leveling the tax playing field--granting comparable tax treatment whether premiums are paid through an employer or by individuals in the private marketplace. For this marketplace to work, consumers also need ready access to information that enables them to evaluate providers on the basis of cost and quality.
Fourth, we must reform the systems that are adding expense and inefficiency without improving quality. Health IT can help control costs, prevent medical mistakes, and help consumers make better health care decisions.
We can reduce costs by improving the level of care, which is often uneven in our country. That's a far better approach than trying to squeeze provider reimbursements that may only temporarily patch up a budget. We should also remove medical malpractice claims from the tort system by creating special administrative health courts, similar to bankruptcy courts.
And Fifth, we need to launch a ground-up revolution in wellness and prevention. A reorientation to preventive medicine could avert 40 million cases of 7 chronic diseases--cancer, diabetes, heart disease, hypertension, stroke, mental disorders, and pulmonary conditions--by the year 2023. This would save about $1.1 trillion dollars. That's real money!
These five ideas may not sound as dramatic or all-encompassing as the big government plans we are hearing about on the political campaign trail. But guess what--they can work. Not overnight, but over time. They can lead us to a health care system of high quality, lower costs, and greater access for all Americans.
I post on health care and other topics on chamberpost.com, we welcome all to the debate. |
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