Who are the real culprits preventing reform?
Los Angeles Times
January 17, 2003
The Unmanaging of Health-Care Costs
By Uwe E. Reinhardt
In referendum after referendum, Americans have shown their distaste for the single-payer approach, such as Canada's, that can control health spending while protecting people from bankruptcy over medical bills with rationing of some high-tech care. Americans showed equal disdain for the Clinton health plan, which sought to control spending more gently with privately managed care, regulated by government.
Now Americans have defeated managed care by employers, virtually the only cost-effective quality approach left for employees.
What Americans want is really quite simple: all the health care they or their doctors can imagine, virtually free, without added taxes for health care and without higher out-of-pocket costs for their "employer-provided" health insurance. That's all. Call it part of the American dream.
As the dreamers watch health care chewing up their paychecks, and as their out-of-pocket payments for health care rise inexorably, the dreamers will stomp their booties in despair and look for a culprit. They need not look beyond the mirror.
Comment: Are the dreamers of their own personal health care utopia the real culprits?
Our message to them has been quite clear. Absolutely everyone can have affordable access to virtually all reasonable, beneficial health care services if only we replaced our flawed, wasteful system of funding care with a more efficient, publicly-administered, single insurance program. That is what they hear from us, but, from their perspective, what is really the truth?
They are intelligent. They know that you cannot add over 40 million individuals to the insurance pool without greatly increasing costs. And they know who will have to pay for that care since most of those without insurance cannot afford to pay their full share now. They also know that if you allow everyone to have all of the care they want, costs will skyrocket because people will automatically overutilize the health care system. Since the system would be publicly funded, people will be taxed to death. The economy will deep six because American businesses cannot afford the high taxes required by such an expensive health care system. Many understand that limiting costs would stifle technological innovation, threatening access to unknown but surely life-saving care at some vague time in the future. And, finally, the government can't do anything right and would wreck our health care system with its burdensome and inefficient bureaucracy.
Any single payer advocate can refute each of these points. But most of us are totally ineffective in convincing individuals that their factual data base is corrupted, and that we have a new information data base that will replace their flawed knowledge with the "real" truth.
Whom do we blame? Is it the dreamers who want health and financial security based on inadequate and untruthful information but on the facts as they understand them? Is it the vested interests that profit from continuing their campaigns of misinformation? Is it the advocates of reform who have failed to communicate adequately the true facts made available to us through health policy science? Is it the politicians who do understand the issues but who are more driven by polls and elections than by policies that would benefit their constituencies? Though this list is incomplete, it seems that we are all culprits.
Is there any hope? The recent Romanow process in Canada revealed that a nation can have a very good grasp of rational health care policy and can maintain solid support of their system in spite of intense political efforts at sabotage. How did Canada manage to arrive at this level of support for their system? It's really quite simple. They've lived with their system for decades, and, through personal experience, they know exactly what it is and how it works. They are not swayed by the vested interests and ideologues that disseminate untrue statements about their system.
Can we ever have that level of understanding in the United States? We can, but it will take a massive grassroots effort in which we all must participate. If we do our best, we will no longer have to accept a share of the blame. On the other hand, if we fail to be a part of the solution, then we will continue to be a part of the problem.