I have put much time and thought into what I think is best for the American health care system, and I've come to some conclusions:
- The current system sucks. Alright, that didn't take much thought and we all know it, but it bears repeating.
- Because of this, we need a major overhaul of the health care system. Again, common sense, but also bears repeating.
- Any system, overhauled or totally new, which does not have sufficient controls on costs will run massively over-budget over the course of a few decades, making an even bigger mess of our national finances than Reagan and Dubya did.
- Therefore, the use of some form of price controlling to contain costs is necessary.
- A blend of what Japan (likely implemented with a semi-centralized pricing system for common procedures and a "reasonable attorney's fees"-type table for operations and so forth) and Germany (with universal coverage for basic care and not for profit insurance available above and beyond that) have is best for this goal.
Now, some background is needed on where I come from in all of this: I was raised a Republican, with respect for the free market and all that jazz. I've still got that in me. I also grew up with a desire for good government, not small government; when they have coincided, that's great, but there are many cases where big government is in fact better, and government-run or government-supervised enterprises will provide better services for the same cost to people than will the free market.
Today, however, the Republican Party has virtually no place left in it for someone who doesn't see good government as being the same thing as small government. Nelson Rockefeller, Dwight Eisenhower, and many others would be run out of the party today (and in fact Rockefeller was booed by the forerunners of today's activists at the party convention in 1964, 45 years ago this summer). Yet the transit corporation he set up in the NYC area provides quite good service to the people of that city and the surrounding area. Whether or not the market built these things, it didn't preserve them. Government intervention did. Likewise, it wasn't the government that killed the streetcar lines, it was the free market.
On health care, the market has failed...and failed in a massive way. The only way that a 'free market' health care system on a fee-for-service model is going to work is if we, as a nation, decide to let far more people die from a lack of coverage and a lack of basic medical care than already do. Seeing as the American people are inclined to express outrage at such treatment when it happens, such a system will not work. We need to let it go; it is hurting people, if not killing them, regardless of who they are or what their ability to pay is.
But if we are to do a government health care system, then we must do it right. Half-measures are often worse than nothing, for they both sap the will to push on and achieve a full solution and they often generate a distorted mess of incentives. An excellent example of this is the three-day hospital insurance that Medicare provides. Result? Hospitals prematurely discharge people (even those with the ability to pay, I'll add), adding stress to already fragile bodies. This is an example, but there are others.
The proposed public option will only work if a mechanism for the government to dictate reasonable prices is included. Only if this exists will prices be kept in control. I say this as someone who wants a good health care system to exist in America...and wants it to be affordable. A lack of such mechanisms has at least in part led to the soaring costs Medicare has faced; we need one, and we need it now. Japan has survived just fine with one for the last 50 years, after all.
As someone who has grown up as a Republican, I have to say that I find myself now very much without a party to call home. It's not just health care, it's the sort of insanity with the birthers and the Birchers (often one and the same, one suspects), the deathers (who in their scare tactic rants omit the fact that private insurance has such systems in place), and everyone else. A fair share of the Republican Party has gone off the deep end; they are concerned with birth, death, and everything in between, and not in a good way.
My concern, as I noted earlier, is the quality of government, not its size. There are things, such as public transportation, which the government must take charge of...something that a large portion of the Republican Party seems to be in the process of losing its hold on. I feel that health care is one of those things as well...but if we're going to do it, we need to do it right or we risk a train wreck.
In closing, I will note that this doesn't deal with the need to cut medical school costs and increase the number of doctors...that's another issue we need to confront, but it's for another day and another rant.