It is well documented that many other countries have created health care systems that are more popular than ours, cover everybody, are more effective as measured by better health outcomes, are better able to restrain increases in costs and, therefore, have per-capita costs that are a fraction of ours.
One of the reasons for the popularity of universal health care systems elsewhere in the developed world is that when everybody is in the same system, everybody has an incentive to make that program work. The people of those countries have a sense of ownership and responsibility for their common system.
That contrasts sharply with the situation here in the U.S., where people primarily and often exclusively are concerned with their own little piece of the system, such as Medicare, the Veterans Affairs, their own employment-based or veteran’s insurance, plans purchased on the Obamacare exchanges, Medicaid and so on.
Americans also are confused about who owns the system. Is it the government, their employer or their union? Or, as more Americans are coming to believe, health insurance companies, the pharmaceutical industry or the increasingly consolidated corporate providers of health care such as large hospital systems?
In other words, we lack the solidarity that both is an expression of and created by the existence of a single common way of dealing with the challenges of providing affordable health care coverage for all.
I’m a great fan of the goals of the Affordable Care Act — expanding coverage, restricting the most anti-social practices of health insurance companies and attempting to control overall costs. But I’m not a fan of how it tries to accomplish them.
Obamacare is based on the concept of choice among insurance plans. Such choice is greatly overrated.
In order to provide choice among insurance plans, something most people don’t care much about, we are losing choice among healers, something we care a lot about. We are discovering that choice of insurance plans comes at the cost of losing our choice of doctors and hospitals, as insurance companies vainly attempt to control their premium prices by restricting their networks of “providers.”
The financial price of giving people choice of insurance plans, the very reason for the existence of the problem-plagued health insurance exchanges, is very high. A recent Washington Post article documents the financial struggles of most of the state-run exchanges, struggles that are expected to last indefinitely.
There are other costs, as well. The complex nature of the health insurance “marketplaces” has created unnecessary anxiety and confusion among those using them. That in turn has spawned the creation of armies of consultants, “navigators” and other helpers to assist people in finding their way through the maze of choices created by the health insurance industry and exacerbated by Obamacare. This only adds to our national health care bill and does not buy one doctor visit, lab test, Band-Aid or aspirin.
Complexity is a huge drag on the popularity of our health care system as a whole. I have written before about the barriers to further reform of our health care system — fear, anger, ignorance, ideology, apathy and greed.
Apathy often characterizes people who already are well covered and don’t see any reason to worry about those who aren’t. They include the 55 million beneficiaries of Medicare and roughly 140 million covered by employment-related insurance who like it so much that they are frightened and angered by any program designed to expand coverage for others, fearful that it will reduce their own benefits.
Our obsession with “choice” among health plans not only is misplaced but economically costly and confusing and itself is a huge barrier to political solidarity. The infighting among groups covered by different plans is a powerful ally of those profiting from and wedded to the status quo. It is an important barrier to the one common sense idea most bolstered by evidence of fairness and of effectiveness — improved Medicare for all.
We urgently need fundamental reform of the way we finance health care in the U.S.
Fundamental change is extremely difficult in politics. But as the race to the bottom created by the folly of attempting to interject more choice and competition among insurance plans becomes clearer, the public becomes better informed about the alternatives and frustration grows, and people in Maine and elsewhere will come to demand it.
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