Watching Jim Cooper yesterday on Face the Nation, I still felt relatively hopeful that we could get HR 3200 passed. Then, I read his editorial in the Tennessean newspaper, where Cooper basically said that he would not vote for HR 3200 in its present form.
And now, I'm wondering if the United States will go the way of GM, or if we'll learn the lessons from GM's bankruptcy.
You might think that this is about fiscal discipline, and in a way, it is. GM went bankrupt because they had an unsustainable business model. They went from being a car company to becoming a financial services company that made cars, then spun off GMAC to become a car company with too many legacy costs.
Like GM, America cannot afford to go on spending money we don't have and still expect to compete in the global economy. And I don't care how well we cooperate with China. We still can't live this far beyond our means, and expect to be a global leader.
As President Obama said, the status quo is unacceptable. Medicare and Medicaid are on a path to bankruptcy. Eventually, either we reform the system at a fundamental level, or we need to sell off Medicare and Medicaid or just cash in our chips and go bankrupt.
But that's not my point.
What We Need: A New Business Model
My point is about the way GM manufactured cars. It's about the engineering - the way GM first perfected the assembly line model, then used it until it became a model that ran itself out of business.
When automation and robotics made the car-making business an inhuman industry, we found that we had to pay the retirement expenses of hundreds of thousands of workers while paying a workforce that was either much smaller, or a workforce that outsourced production to a foreign country. We have to do more with less.
And that's where healthcare is headed. What's unfortunate in this whole process is that 1) we have lost the human element in healthcare as technology has replaced caring humans, and 2) we rely on healthcare consumers to be self-regulated in order to make the system work.
And that's the biggest issue. Healthcare is not about relationships anymore. It's about automation - a system where it takes 10 seconds to write a prescription and an hour not to. This is a system where drugs have replaced therapy. The goal for hospitals and insurance companies is to minimize the amount of time where a provider actually spends time with a patient. The more patients, the more profits. And the reason we feel like we're being herded like cattle is because we are.
Our healthcare system doesn't work in a for-profit model because efficiency in healthcare requires us to be inhumane. And that runs contrary to our values.
Another thought... about reform...
Jim Cooper talked about "craftsmanship, not authorship". In other words, we shouldn't be as concerned with WHO writes the bill as with HOW the bill works. The outcomes Democrats want are all the same - we want (you can quote it just like me) QUALITY AFFORDABLE CARE FOR EVERY AMERICAN. Access, cost, and quality are the key measures of success. But high quality and easy access usually translate into higher cost. UNLESS...
We find another way.
Unless we can build a new model, we're not going to get things fixed.
We can build off the old model - employer-based tax-deductible health insurance - or we can scrap the old outdated model and do something new.
Making Better Products
I remember when minivans and SUVs were cool. You could improve gas mileage because you were building a truck frame on a car engine. They were roomier but still got reasonably good gas mileage. And to an extent, that worked for a while.
But what we really need in order to get to energy independence is a new engine. We need a new power source. We need a new way to make things work at a fundamental level.
Right now, the race is on for improved battery technology so that electric cars are a legitimate possibility. If we can run on electric, then we don't need to refuel as often. We're almost there - but GM didn't get out in front in time to lead with the Chevy Volt or other electric cars. And that, as much as anything, is why GM failed. They got beat in the technology race because they couldn't re-invent themselves fast enough.
American healthcare is truly the best quality in the world. For those with enough money, there are almost limitless possibilities to receive care and even to reinvent ourselves through surgical techniques. The problem isn't quality. The problem is cost and access. And just like you can get electric cars right now, you can get a top-quality healthcare plan today - if you have enough money and you know the right people.
But we've taken this model as far as it will go. We're going bankrupt as a nation under the current Medicare/Medicaid/employer-based insurance model. (This is in no small part due to the irresponsibility of the Bush Administration and the warped decision to invade Iraq.) And just like you can't put a car engine in a semi and haul a heavy load uphill, we cannot revise the current healthcare system and expect to cut costs enough to get us out of debt.
So...
Doing nothing is not an option. We'll go bankrupt.
Revising the insurance system is not an option. That broken model won't work.
We need a new model and a new system.
The options are either:
- Single Payer, where we cut out the middle man of insurance altogether
- A robust public option, where we make a major public investment on the shoulders of the wealthiest Americans in order to drive reform and increase access, or
- A new tax system, where we provide universal access based not on employment status but on citizenship, and require every American to play his or her part in making smarter healthcare consumer choices.
I'm personally partial to the Single Payer option.