The politics surrounding the American healthcare system are a mess. The process by which health care reform passed was unappealing, and the result was not anyone's ideal solution. Polls show that voters in the 2010 election had some important misconceptions about the new law. The Republicans elected to the new Congress have sought to repeal that law and have voted to gut Medicare in the years to come. Perhaps it would be best to step away from this mess and begin with well-established facts.
1) Americans pay about twice as much for their health care as the citizens of other advanced societies.
2) The health care received by the American people is, overall, worse than in most other nations like ours. We rank first in the world in health costs but 37th in health outcomes.
3) A Harvard Medical School study estimated that 45,000 Americans die every year for lack of health insurance--no other industrial democracy has that problem.
Those facts by themselves should make us conclude that the American healthcare system needs to be changed. Paying a lot more and getting a lot less is not a situation that an intelligent people should accept. But the Republicans have done all they can to prevent America from reforming this wasteful system.
1) When a Democratic President tried to reform our healthcare system in 1993-4, the Republicans blocked any change.
2) When the Republicans controlled the American government during the past decade, they made no effort to institute any solutions to our massive costs-vs.-benefits problem in healthcare.
3) When another Democratic president tried to reform the system in 2009-2010, the Republicans again did everything they could to stop change..
Whatever one's evaluation of 2010's Affordable Care Act, one political party has made an effort to address this major problem while the other party seeks to maintain a status quo that is enriching some companies in the healthcare industry but is bankrupting the country.
And that brings us back to Medicare, a popular and, by most accounts, highly successful program that takes care of the healthcare needs of America's older citizens, and that the Republicans have now shown they want to eliminate.
The reason given for this assault on Medicare rests on another fact: Medicare is a major part of the dangers facing the finances of the federal government. The projected increases in the costs of operating Medicare seem unsupportable. This is not a Republican scare tactic; this is reality. To see what has to be done, we need to look at these additional facts:
1) Medicare is better than the private American healthcare system in delivering good care for less money.
2) The rising costs of Medicare are just a part of the larger problem -- for decades in the U.S., healthcare costs have been rising faster than other costs.
3) Rising healthcare costs hurt not only the federal government but also families, and businesses that provide their employees with private insurance.
4) If the costs of healthcare in America were like those of other advanced societies, our budget deficit problems would disappear. We would even be running a surplus.
So we can conclude that this country does not need to gut Medicare (as in the Republicans' Ryan plan). Just the opposite: We need Medicare Plus. The first stage might be instituting that "public option" that was suggested earlier: specifically, allowing everyone to enter the Medicare system, if they choose, but without government subsidy.
If government really can't do anything well then private health insurance companies should be able to beat the public option in fair head-to-head competition. But if the private companies cannot deliver good care as cheaply as the government then gradually the public option would become a single-payer system.
A single-payer insurance system should be able to achieve universal coverage, saving thousands of American lives. It should also be able to achieve that additional and essential goal: bringing health care costs under control. It can reduce costs in these ways:
1) using the weight of a huge single-payer to negotiate lower prices from private providers
2) using an expanded version of the Medicare administrative system, which adds only about 2% for administrative costs, compared with almost
3) changing the system of incentives for providers from "procedures performed" to "care given"
4) providing empirically based guidance on medical efficacy to eliminate medically unnecessary forms of care.
The United States has run an experiment for several generations. While the rest of the world was treating medical care the way that we treat education for our children---as a right of citizens, and as something to be provided or regulated by government--the United States alone tried out the private-industry approach.
The results are in. Our approach delivers less bang for more bucks. And by the criteria of the market, and of America's famous pragmatic approach to problem-solving, it's time to move to the next stage, which I would propose to be: private providers, public administration