The nation is not in the midst of a healthcare crisis. The bubonic plague would be a healthcare crisis. Right now the country is simply more aware of its painful situation. We have reached a point where we can do more for more people. The question is, "Can we do it affordably?" To make healthcare affordable means to reduce the need for it and to reduce the cost of it. Reducing the need is significantly in the hands of the individual through choices in lifestyle and seeking appropriate preventive and palliative care. Unfortunately, unless everyone does this, the cost benefit to the individual is lost in the pool of all those insured. The prudent person has better health, but not lower costs because less health-conscious persons use the savings. A personal financial incentive is currently missing.
Reducing healthcare costs requires a national initiative to truly systematize the process of healthcare to improve: standardization of records and insurance coverages, exchange of best practices, transparency of information regarding provider fees and success rates, affordable training for additional medical personnel to treat a growing and aging population. Just one example would be the creation of a linked database of provider healthcare records so that any provider, anywhere in the country could access complete and current patient information when needed. Persons with privacy concerns could opt out or could carry their information on a computer chip in their wallets or key chains. It will take big steps to solve a big problem. Small enhancements will not make a material difference.
Solving the problem of extending healthcare to the uninsured requires mandating coverage regardless of existing conditions, government subsidy of premiums for low-wage individuals and families, and increased free public clinics. Some of this already exists, but expanding it requires the willingness of everyone else to pay more taxes so that all citizens can access at least a reasonable level of care. Limits on public-paid care will be required. Free care does not mean unlimited care. The price of free care will be a ceiling either on individual treatments or lifetime benefits. The public purse is not bottomless. It is sustained by the tax paying generosity of fellow citizens and the nation’s need for productive functioning.
Behind much of this discussion has been the assumption that the money pie is relatively fixed and that we must allocate it to different items, including healthcare. If healthcare needs a larger slice, then something else will get less. Another viewpoint is to grow the size of the money pie – our national wealth as individuals created through our earnings. If everyone was wealthier, more people could afford healthcare. The government would have more tax revenue without raising tax rates and that could fund more public healthcare. Such an increase requires the nation to increase its productivity which rests on the skills of the workforce and the availability of capital for investment. Perhaps the way to more healthcare is through a better educated workforce.
Finding the right balance of the five Cs of cost, control, content, contribution, and compassion will not be easy or quick. Rushing a 1,000 page bill through Congress in six months does not look like the way to a workable solution. Political urgency can produce poor social engineering because importance and urgency are not the same thing. Only with a shared frame of reference, a willingness to be more logical than partisan, and to be more practical than political, will we be able to find a better way. Is Congress capable of this? We shall see.
As we look forward, it may be useful to look backward in history. Thomas Jefferson had this to say about government: "The government is best which governs least, because its people discipline themselves." And Alexis deTocqueville, a marvelous observer of America in the early 1800's, said: "The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money." The more things change, the more they are the same.
Postscript
Over the years, I have experienced a lot of the healthcare industry as a consumer. I have had extensive family dealings with doctors, hospitals, private insurers, Medicare, and TennCare. I’ve dealt with insured and uninsured situations. I have been an employee and a self-employed business owner. The cumulative medical bills I have seen easily reach six figures. I have witnessed good medicine and poor medicine – both for the same price. Getting good care does not always come easy, regardless of your insurance situation. There is ample room for improvement so that a healthcare dollar buys more.
What have I ultimately learned?
- Stay as healthy as you can.
- Stand up for quality care for your loved ones.
- Always be insured.
A great read Don. I think you hit upon or at least touched just about every issue that needs to be addressed in the near future.
ReplyDeleteI have been annoying my friends on FaceBook and my own blog, not because I have ever been an "in your face" political type before, but because this subject is so important to all of us. I challenge anyone to find me a more "non-partisan" topic. Yet sadly, the "debate" - and I use that term in its loosest possible sense - has become nothing so much as partisan bickering, which has closed off so many possible solution routes that I fear nothing meaningful will be accomplished.