MISSING: THE LANGUAGE TO FIX AMERICAN HEALTH CARE FINANCE
The Supreme Court arguments this week have been riveting - good theater for those who care deeply about our American health care system.
But our health care debate is missing the point – all the way to the Supreme Court.
In June, when the Supreme Court has acted, it will seem like we have a new reality:
- Patient Protection and Affordable Care Act (PPACA) - or not
- individual mandate - or not
- expansion of Medicaid - or not
But very little will have changed. We will still have the same framework of health care finance – the most expensive health care in the world, with unenviable outcomes to boot. The PPACA is a patchwork of compromises into which we are forced while we evade the real questions.
It is impossible to find the right answers if we ask the wrong questions. To paraphrase Einstein, a “new type of thinking” is needed … we cannot solve our toughest problems with the same kind of thinking which created them.
And so:
- What is the new kind of thinking?
- What are the right questions?
- How will we find the language to ask ourselves these questions?
We ask the wrong questions because our healthcare system is the only one we have ever known. And because our language about healthcare is formed by what is familiar. And because– to many – it has become unpatriotic to raise any questions about our American way of life: to think, to question, to dissent.
But what is our system? It blends some of the best and worst characteristics of our American society:
- A system where health care access is not universal, but is related to individual economic success
- A system where health care finance evolved from fee for service - long, long ago - to third-party payments through insurance
- A system where health insurance became subsidized through employment rather than an individual responsibility, and thus an a “benefit” of employment
- A system where the employee benefits of employer-subsidized health insurance can be shielded from taxation – and the broader the coverage, the greater the shift
- A system where health insurance has shifted from community protection against disaster to a highly profitable enterprise which emphasizes profits over health care services
This is a system which values economic interests more than patients!
If we hope for unfettered free-enterprise, unlimited profits and optimized quality of health care all in one package we must be prepared for the inequities which result.
The PPACA is a flawed compromise - unavoidable until we can find a new mix which answers the right questions:
- How to achieve universal coverage
- How to provide affordable health care coverage which is unlinked from employment
- How to provide basic health coverage which is unlinked from for-profit insurance
Such a new system would not necessarily require so-called “socialized medicine” or even single payer. Other countries have achieved this. But it does require answering these questions in new ways, with dedication to reducing inequities in our health care.
How will we find the language to do this?
3/31/12 @gtruebel