By Jack Meyer
Health Affairs Blog, July 24, 2019
The debate over the future of the US health care system has entered a fact-free, extremist zone that will continue to impede progress toward the critically important goals of moving to universal health coverage, improving the quality of care and patient safety, and controlling the growth of total health spending. The polarization of the health care debate will leave us in gridlock and block any bipartisan approaches to universal coverage that can be enacted and implemented.
Sabotaging The ACA
On one side of this debate, the Trump administration has been repeatedly sabotaging the ACA, while offering no constructive alternative.
Living In A Dream World
On the other side of the debate, most Democratic presidential candidates are shouting “Medicare for All” without explaining how that would work or how we would get from here to there.
A Better Approach To Achieving Universal Health Coverage
There are constructive, feasible, and affordable pathways to universal coverage that build on our mixed, public/private system.
Linda Blumberg, John Holahan, and Stephen Zuckerman of the Urban Institute have developed a plan to move toward universal coverage that allows people to keep their employer plan if they are satisfied with it.
The US needs to stop the ideological battle over the ACA and develop a realistic, affordable plan to move to universal health coverage. Instead of repealing the ACA or forcing people out of private coverage, we can construct a mixed public/private approach using large building blocks to forge a solid structure. No sabotage, no mandates, no villains, no easy sound bites. Instead, a blend of pluralistic approaches to affordable coverage using expanded public subsidies, private insurance, and sensible regulations.
Health Affairs Comment:
By Don McCanne, M.D.
There is absolutely no question that a well designed single payer model of reform is vastly superior from a policy perspective. It automatically includes absolutely everyone; it reduces administrative waste by hundreds of billions of dollars each year (not each decade); it improves equitable distribution of our health care resources thus improving access; it is financed equitably so that no person is exposed to financial hardship, and it uses public policies to slow future health care spending to sustainable levels. Incremental measures, such as described here, only add more layers to our highly dysfunctional health care financing, thus perpetuating inequities, inefficiencies, ineffectiveness, and ever rising health care spending. The problem is not with single payer policy, but it’s with the political path to get there, as this article implies.
It is a terrible error to automatically compromise on policy in order to clear a pathway through the politics, yet that is how it is typically done. What we should be doing instead is change the politics so that we can enact and implement the optimal policies that work best for all of us.
The first step should be to have a little more honesty in our national dialogue on reform. Instead of discussing how well selected policies work for the dysfunctional elements of the existing system, we should be discussing how well optimal policies (single payer) would benefit the patients, and then be sure that the public is educated on the differences. Difficult? Sure it is, but this multi-trillion dollar industry is being funded by us, the people, and for that level of spending we should be demanding optimal value – high quality health care for everyone.
By Don McCanne, M.D.
Think about these two problems society faces:
- We have the most expensive health care system in the world yet it is failing us in preventing much avoidable suffering, financial hardship and premature death.
- We have a political system that serves as a barrier to problem #1.
So what have we been doing? We first approach problem #2. We decide that we have to agree to compromise and then we decide what health policies can survive the compromise process.
Through the decades, we have agreed on policies that sacrifice universality, access, affordability, efficiency, effectiveness, and especially equity. Yet we have defined this as success because we were able to negotiate the politics.
We still see that today. Forget the dream world of a high performing health care system that’s affordable and takes care of everyone. Let’s spin our wheels on the real challenge – achieving political compromise – but to do that, we have to dump the beneficial policies that actually would work for all of us. In other words, we must tackle the barrier to reform – problem #2 – by sacrificing real solutions for problem #1 – our health care.
As stated above, we need more honesty in our national discourse on reform. People need to understand what really would work best for them. By placing a priority on policy, you would hope that the politics would align.
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