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Envisioning America’s Health

The time for health care reform has come.  But in order to implement specific policy reforms, we first need a health care vision — a vision that recognizes our health is a fundamental precondition of liberty; a vision of Americans taking responsibility for their own bodies and minds; a vision that sees the connection between, on the one hand, quality and affordable health care that works for everyone and, on the other hand, quality of life, the pursuit of happiness,  jobs, the economy at large, scientific advancement, and innovation.  We have to visualize these connections every step of the way.

The first step to reform is realizing that our current system of private health care is terribly bloated and broken.  When it comes to health care, we are presently a backward nation.  The facts speak for themselves.  Since 1960, total national health expenditures as a percentage of GDP have more than tripled.  The expenditures are growing at about two times the rate of inflation and, in 2007, totaled $2.2 trillion, or $7,421 per person, well over 16 percent of GDP.  Despite all the money that is spent, almost 50 million Americans remain uninsured.  Meanwhile, France and Canada each spend less that 10 percent of GDP on health care, but all of their citizens are happily insured, and have higher life expectancies than Americans to boot.

One American goes bankrupt every 30 second because of their health care costs.  About 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs.  All the while, insurance companies boast massive profit margins, as does Big Pharma and so many others in the chain, while fraud and inefficiencies pervade the system.  Moreover, since under the current regime health insurance is typically tied to employment, when employment ends so does your health care, leaving many more Americans twisting in the wind during difficult economic times.

Health care is an issue that politicians, and Americans generally, have swept under the rug time and again.  The last major moves by government were Medicare for the elderly, and Medicaid for the poor, both under LBJ.  The Clinton Administration tried in 1993 to enact a plan for universal coverage via a national health care plan, but was roundly defeated by a combination of well-funded industry special interests that demonized the plan as coerced “socialism” and, to some degree, public indifference and therefore malleability.  There was, of course, Harry and Louise, the fictional couple who “sometime in the future” sat at their kitchen table complaining that “they choose, we lose.”  William Kristol wrote in the Wall Street Journal that the Clinton plan “in any form would be disastrous . . . the rebirth of centralized welfare-state policy.”  Molly Ivins suggested that the idea of universal health care comes from “Russia . . . straight out of the pit of hell.”

Though it is not going end anytime soon, this kind of hyperbolic rhetoric has little, if any, connection to reality.  The truth is that it makes a lot of sense for government to help find ways to enable all Americans to get proper health care.  And to find ways not only to cut costs, but to better allocate them.  The key insight must be that health care is not a run-of-the-mill market commodity.  It’s an essential service.  It is, quite literally, the condition of possibility for life, liberty and the pursuit of happiness.  There are some areas of the economy where letting market forces run hog wild may be supportable.  But the health of our citizenry is not one of them.

One problem, as psycho-linguist and progressive thinker George Lakoff notes, is that health care issues are framed as health care insurance issues.  The uncritical acceptance of the insurance frame legitimates a host of features:  profits, claims handling, administrative costs, premiums, actuaries, outsourcing, care criteria, denial of coverage to maximize profits.  Insurance companies are unique in that it is in their best interest to provide as little service as possible.

Ask yourself:  Does it make sense to make our national health contingent primarily on organizations required by law to act in the best interests of their shareholders, and precluded by law to act in furtherance of the common good?

The Fix

President Obama has correctly made health care reform a primary goal during his first year in office.  Some argue that with a crisis economy on his hands, the president should not try to walk and chew gum at the same time.  The truth, however, is that health care is an economic issue.  In dealing with the health care problem, we are at once solving a huge economic drain on our system.  Within a few months after Obama’s inauguration, Congress was able to get a budget passed that earmarked over $650 billion for health care, funded by cutting subsidies to the hospitals, insurance companies, drug companies and letting the deep Bush tax cuts expire for the wealthiest Americans.  But the details of the plan have not, at the time of this writing, been fleshed out.

Health care reform in the 21st century should achieve four goals:

First, it must reduce costs.  The other extant models of health care in Canada and Europe not only provide all their citizens with coverage, but demonstrate incontrovertibly that America’s health care costs are aberrant and out of control.

Second, we must make health care portable.  Tying one’s health care to an employer is a vestige of the 20th century industrial economy where many people had careers consisting of a single job.  The 21st century economy is different.  People are moving around a lot more.  Employers are moving, changing business models and adapting to a dynamic globalized environment.  The health care of Americans cannot be subject to these vicissitudes.  Nor should the decisions of employees nimbly to respond to changing market conditions be constrained by their need, indeed right to get proper health care.

Third, health care must be accessible and therefore affordable to all Americans.  The vast majority of Americans are uninsured because they can’t afford it or, in some cases, because  insurers won’t accept them due to pre-existing conditions.  How did we get to the point where the health care system is steeply biased against the people who need care the most?

Finally, we must ensure that the quality of our health care is first-rate, taking heed of that long-forgotten adage — an ounce of prevention is worth a pound of cure.

So how do we get there?  There’s a couple of different proposals:

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