Healthcare reform is not this

posted by Jeff | Tuesday, June 27, 2017, 11:00 AM | comments: 0

Congress is trying hard right now to take on the issue of healthcare reform, but the result is not the reform anyone is looking for. If you were to define the desired reform as broadly as possible, it would likely be to devise a system that results in lower costs and better access for everyone. I'm positive that not everyone wants that, but it seems like that's what the majority of Americans want. The new legislation doesn't make it cheaper, and it reduces access. It feels like it's almost just to spite a former president that left office six months ago.

The problem is pretty well defined: Healthcare is paid for by insurance, which is generally tied to employment, which is generally tied to socioeconomic opportunity. While I understand some people adhere to a strong ideology that access to healthcare is not a right, I am troubled by this because we don't really get to choose our health. One day, we can simply learn we have cancer. When we're children, we have no choice as to who our parents are or whether or not they're in a position to obtain healthcare for us. It's like the lottery, only we're all forced to play, and the consequences are a reverse lottery slogan: We're all in it to lose it.

I don't know what the solution is, and the Affordable Care Act only partially solved the access problem, but did little for the cost problem. Repealing the provisions that at least partially address the access problem, reducing the insured by 22 million, is not a win. I don't think our lawmakers really understand the economics involved here, because they see them only from the view of government expense. However, the poor get poorer when they can't afford care, and frankly even the well-off risk financial ruin when they can't pay. There are a hundred ways that the poor drag the economy, and that affects everyone. Further, think of the missed opportunities: People may stay in a job that they're not well suited for only for the health insurance, or worse, are unlikely to risk starting a new business that could have a ripple effect of growth for others, because they are too scared to leave their job for the health insurance.

Other nations, most of them even, have taken a more hands-on approach that results in higher quality care at a lower cost, particularly if you measure that care by life expectancy. The US spends the most per capita but ranks in the 40's for life expectancy. We don't get "better" for our money. Everyone else has some variation on single-payer systems (consolidated risk pools), national administrative systems, etc. Opponents describe these as broken, expensive systems while failing to acknowledge that we have a broken, and more expensive system. That seems intellectually dishonest. If we can't even have the conversation about the way others do it, then we aren't having a debate. We're only killing the conversation on the basis of high ideology that today offers no solution.

We can't innovate in the US either, because of existing regulations. There was a time before the Great Depression when you could pay a flat fee to a local co-op of doctors and hospitals, all of whom shared information and managed your care, but you can't do that now because it would run afoul to insurance regulations. We know that the inability to coordinate and share information is part of the problem, and this would help, but you can't do it.

What's most disappointing is that after seven years of saying that the ACA is a disaster, without qualifying what makes it a disaster, the GOP leadership has completely failed to architect an alternative that works for everyone. It's an enormous missed opportunity. They've been so busy pitching a way to save us from the past administration's signature legislation that they've completely neglected a way to save us with something better. That might appeal to the base that just wanted to stick it to the former president with a funny name, but it's not leadership.

As long as we fail to debate ideas in favor of supporting politics as a sports rivalry, we will get nowhere. Demand more from your government.


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