Following the turmoil surrounding the failed Republican repeal of the Affordable Care Act, we still face our chronic health care problems.
Americans pay at least twice as much per person for health care as any other advanced society, yet we maintain a wasteful, inefficient and woefully inadequate system.
We have yet to embrace the idea – so prevalent elsewhere in the developed world – that health care is a right, not a marketable commodity.
With its fee-for-service orientation, our medical establishment focuses far too little on the issue of how to keep us healthy. While individual physicians, especially in general practice, work very hard to help us prevent heart disease and other lifestyle-based illnesses, and pediatricians help parents focus on well-baby practices, the medical system as a whole tends to wait until we are sick and then tries to cure us.
Unfortunate for us all, our medical and pharmaceutical industries pursue a business/profit ethos.
My brother, who is in family medicine, tells me: “Like most of our patients with insurance, we doctors have little relationship to the cost of what we recommend and prescribe. There are no penalties for over-prescribing tests and procedures. It’s the culture that has to change, but with economic forces pushing doctors into ever bigger groups and ever more specialization, the unique doctor-patient relationship – which fosters common-sense decisions – is continually eroded.”
He continues: “The medical profession is hopelessly poor at successfully promoting health. We spend a great deal of our time advocating weight loss, exercise, a prudent diet (whatever that happens to be this month) and smoking cessation, with miserable results. We just don’t know how to do it, nor does anyone else.”
The solution to our dilemma may, however, be reachable if we don’t retreat into our familiar ideological sanctuaries, or gird ourselves for a set-piece battle between conservatives and liberals instead of working together to seek solutions.
In an attempt to find common ground, I, as a layman, offer five proposals. I do not anticipate a quick fix. What I foresee is a set of core principles that can set us on course toward a comprehensive solution. The specifics are of course debatable – nobody is going to like them all – but a solution must be forged from both liberal and conservative perspectives
1) What if we were to move toward a single-payer system (bypassing most insurance companies, their bureaucracies and profit margins) for an agreed-upon basic benefit package, plus a variety of “patient’s choice” supplements that could be purchased from private insurers? But the basic benefit package has to be good enough so that only those seeking opulent medical attention will seek the supplement.
What if we also combine reasonable tort reform with government-subsidized malpractice insurance for health providers, to greatly reduce the incidence of “defensive medicine” and the overuse of tests that drive up health care costs by a huge percentage?
This is one example of how liberal and conservative goals can align.
2) What if we placed greater responsibility on each individual and family to lead healthy lives, while providing children, youth and adults with the best information to achieve that? This requires us to deal with the high levels of chronic stress that plague the poor and disenfranchised and often lead to unhealthy “self-medication.”
We can responsibly discourage access to unhealthy substances that prey on those parts of our brains still wired to seek gratifications that might have served us eons ago but no longer do so.
What if cigarettes and nicotine substitutes were available only by prescription, and processed foods loaded with sugars, fats and empty calories were stored in what is now the cigarettes section of the supermarket, so people will have to ask for them?
Let’s keep in mind that marginalized people in America are often plagued by toxic environmental factors, and children and others who experience trauma are much more likely to suffer from obesity and addiction. But we may never hope to enlist our conservative fellow citizens in the struggle for social justice unless we embrace their focus on “personal responsibility” and combine it with national programs to reduce the prevalence of these unhealthy lifestyle factors and take seriously the challenge to improve the quality of life for all of us.
3) What if individuals enrolled in our universal Medicaid-type system were asked to fill out a “healthy lifestyle” inventory during their yearly health check-ups? Adequate prevention and treatment programs for addiction and obesity can be offered by schools, neighborhood centers, faith-based organizations and corporate employers. We need to place emphasis on helping people understand and ameliorate the life conditions that lead to addiction, rather than just treating such afflictions as the problem.
But “personal responsibility” must be linked with government-sponsored health promotion, and with the elimination of those environmental dangers that inflate healthcare costs and wreck lives.
4) What if the federal government were to purchase a drug company, or create its own, to make available reasonably priced medicines, vaccines and antibiotics to deal with recurring illnesses and potential epidemics like Ebola or avian flu?
Government-run laboratories could recruit idealistic young scientists and technicians (helping to pay for their education in exchange for several years of service). They would, in turn, spend their time discovering, evaluating and producing useful medicines rather than tweaking existing drugs for high-cost advertising and profit.
This combines the conservative idea of competition with the liberal notion of government support for research.
5) What if funds for community-based clinics and for health care, disease prevention and mental health care were borne by federal and state taxes, as well as by tax-deductible donations?
We could thereby help people come to terms with stresses and conflicts that stem from trauma and lower the human and financial costs of relying on our emergency rooms and our prisons. Some people go to our emergency rooms to find warm food, clean sheets and someone to listen to them. Offering such services through community and faith-based programs will result in dramatically lower health care costs, another way liberal and conservative ideologies make substantive reform possible.
The details are arguable, but the “bottom line” is that conservatives and liberals must come together to work out a new and sensible approach that embodies core principles of both, while agreeing to a major restructuring of both how we fund health care and how we provide it.
We should not have to choose between a comprehensive single-payer system and the right of individuals to spend more money on their health (as they already do). And liberals must embrace the notion of personal responsibility, even as conservatives must wean themselves from anti-government hysteria.
Both must join to face down those who profit from pandering to our unhealthy appetites and from patching us up due to its consequences.
(Robert L. Fried of Concord is a retired educator who is now a writer, gardener and tinkerer. He can be reached by email at rob.fried@gmail.com.)