The citizens of every other industrialized democracy in the world have expressed their concern for the well-being, health and lives of others by providing them access to health care. Somehow, the United States, richest nation of all, has not done so.
To some Americans denying health care seems barbaric and inhuman; to others it is simply good business--so good we spend one and one-half times more on health care than any other nation.
Our country made a belated start by international standards in 1965 when President Lyndon B. Johnson, with a largest-ever election mandate and a two to one Democratic Congress, passed Medicaid and Medicare. But, except for nibbling at the edges, nothing more has been done for over 40 years.
We remain passive and paralyzed although the number of medically uninsured has increased by about one million a year since the advent of Reagan in 1981. And, we are doing little about health care expenditures continuing to increase at an unsustainable two-three times the growth of the economy.
Concerned Americans and health-policy veterans, who once believed universal access to care would follow Medicaid and Medicare in a decade or less, are now frustrated and uncertain about when, if ever, we will provide basic medical care for everyone.
Some say we must await a perfect storm, a catastrophic war or another Great Depression. Others think a lesser phenomenon like the one-party control of the mid-60s can make possible the necessary legislation.
A minority believe just simple compassion and reason may prevail. People someday may realize prompt treatment of a child’s infected ear to prevent deafness is more important than paying one greedy United Health Group executive over $1.5 billion in one lump sum.
Fortunately, two very strong currents are identifiable and growing among the eddies and whirlpools of health care confusion.
One is states--Massachusetts, California, Wisconsin and, to a degree, nearly every other state--are trying to find health insurance for everyone in their state.
They can’t do it, because state universality would require high state taxes and/or mandatory play or pay requirements of employers. And only Hawaii, and perhaps Alaska, can maintain a satisfactory business climate with costly mandates or taxes, and nearby state lines.
The other growing current is generated by employers who want to rid themselves of the smothering costs of health insurance for employees and retirees. At each opportunity, they are pushing costs off on employees, or simply discontinuing health insurance. They must act because health care costs are diminishing their competitiveness, domestically and internationally.
So, any new ideas? Perhaps old ideas repackaged.
Let’s make states responsible for health care. Excepting for sharing costs, setting minimal national standards and discharging obvious federal responsibilities, let’s get Washington out of way.
You may call it a blow for federalism, or even for states’ rights; but it’s a good conservative way to deliver health care that liberals can buy into. One size does not fit all. Competition does not work between United Health Group and Wellpoint; it may among 50 states each with new ideas and trying to do a better job.
Initiation of state responsibility for universal health care can be done simply and with minimal disruptions the present system.
The feds can simply say to the states you do A, B, C, and D, and we, the feds, will send you a variable percentage of costs, not unlike federal Medicaid reimbursement which includes greater support for poorer states.
For federally-assisted, universal state health insurance to work, America must get rid of two huge roadblocks that distort the cost and delivery of health care.
One is employer based health insurance, stop-gap measure of WWII that has out-lived its usefulness. Get rid of it, and we will stop the migration of automobile assembly plants to Ontario and other industries elsewhere.
The other is private “health insurance,” also a recent happening. The insurance concept never fit health care. Insurance is for unforeseeable catastrophes, not paying for aspirin. Their overhead, distorted risk pools and intrusions into medical practice make their continuation unwise and intolerable.
More later on A, B, C and D.
Dr. Roy may be reached at firstname.lastname@example.org