By Winthrop C. Dillaway III, M.D.
The Star-Ledger (N.J.), April 18, 2012
In 2009, when President Obama began his term of office, the U.S. health care system was painfully dysfunctional. He announced an initiative for health care reform. Early on, “universal health care” garnered thought and attention. Unfortunately, with the ensuing debate and politics, the concept of universal health care faded and disappeared.
On March 23, 2010, the health care reform bill was signed into law with considerable fanfare. Genuine goodwill and effort contributed to the final product and many aspects of the law are laudable. Nevertheless, two years later, the health care system in the United States remains painfully dysfunctional. Why? What is right? What is wrong? And whatever happened to universal health care?
T.R. Reid, Pulitzer Prize-winning journalist and author of the best-selling book “The Healing of America,” makes three powerful observations: First, all other leading countries provide universal health care at half the cost and higher quality than the United States does. Second, he points to the remarkable variety of health care systems in those successful countries. Third, and most important, what those successful systems have in common is universal health care. Reid states, “Every developed country except the United States has reached the same conclusion: Everyone should have access to medical care.”
The questions about universal health care jump out. Is it a fluke? Why and how do 100 percent of those societies achieve universal health care while America doesn’t come close? Or, perhaps, does universal health care intrinsically offer leverage over management of cost and quality?
Two major obstacles prevent serious comparison of U.S. health care to that of other countries. First is the sheer enormity of the U.S. system; size, cost, complexity, competing expectations, history, politics and, especially, vested interests. Second, that success elsewhere comes with so many different systems. It is nearly impossible to imagine how or what could be captured to improve the U.S. system. Nevertheless, the key to simplifying, clarifying and moving toward a functional, cost-effective and fair health care system is hidden in a paradigm shift to the concept of universal health care.
Here’s how: All health care systems face the triple challenges of access, cost and quality. With universal health care, access is fixed, leaving only two variables: cost and quality. Furthermore, policy makers who want to provide health care to all would naturally be forced to focus on cost and temporarily set aside the third variable, quality.
To focus on cost, all successful health care systems (in fact, all successful businesses) must and do have overall budgeting, accounting, overhead control and insurance risk-pooling. The U.S. system fails and ignores all four areas. No wonder the U.S. system, even reformed, is so dysfunctional. Of course, the vested interests would lobby fiercely against change in these four areas. Nevertheless, this exposure would finally allow Americans to understand what is wrong and what is right, and to see a clear path to legitimate reform.
And what about that third variable, quality, that was temporarily set aside to focus on cost? It’s no fluke that essentially all successful health care systems boast higher quality than that of the United States. (It’s a fallacy that the United States has superior quality health care.) With budgeting, accounting, overhead control and reasonable risk-pooling in place, patients are going to demand the most for their money. Quality becomes the ultimate and lasting focus for any decent health care system.
Society and policy makers need not be overwhelmed by the complexities of health care systems.
Reid points to an invaluable paradigm: simply determining, first, that access to health care be available to all leads to solutions for cost and quality. Confounded by deep experiences and the complexities of life, it is human nature to overlook the obvious.
Imagine the profound benefits to all with the discovery and implementation of this simple paradigm shift to the power of universal health care.
Winthrop C. Dillaway III, M.D., of Morris Plains is president of the New Jersey chapter of Physicians for a National Health Program.