The Democrats on the left of the party, exemplified by Elizabeth Warren, Bernie Sanders and Kamala Harris, are running away with the health care debate.
The problem for those who, like myself, want to see health care extended and rationalized is that the real goals of reform have been abandoned for “universal health care” as an ideological and political goal; add a political prejudice against corporations and the idea of the most health care for all of the people gets lost, as it did in the debates.
There should be only two goals in health care reform: bring down the cost and see that everyone is covered.
We in the United States have the costliest medicine on earth. We also have the spottiest and most risible coverage. We spend over 18 percent of our Gross Domestic Product on health care, nearly twice the cost of health care in other advanced countries like Britain, France, Germany and Holland. That is a huge cost, making us a less-competitive country. It comes not from medicine but rather from inefficient management.
We are a nation that venerates its business culture, but in health care, as it stands, we are protecting inefficiency as though it were a system. There are better ways, short of upending the whole structure, as Warren, Sanders and Harris would like to do, of fixing the system.
Serious reform is seriously needed.
Children’s National Hospital in Washington, for example, I am told, employs 150 people just to deal with the insurance companies, negotiating payments, securing permission for procedures and protesting disallowances. Presumably, there are as many people in the insurance companies on the other side of these transactions.
None of this huge personnel deployment is delivering health care or serving medicine. They are engaged in health care’s equivalent of a souk — bargaining care for money. It should change because it is enormously wasteful, let alone because it fails in its mission: delivering care to the sick.
Remember the old military saw: We had to destroy the town to save it.
In full bay at the Democratic debates in Detroit, Warren, Sanders and Harris were in competition both to junk all private health insurance and to trash the companies that provide it.
I have spent three decades studying health care delivery. While I am an unalloyed admirer of the National Health System in the United Kingdom, it is not for the United States. Not now.
I know the NHS: It has treated my family well since its inception and, briefly, myself. But I do not think we can trash what we have here root and branch and install a duplicate NHS. We have too much that would have to be changed; too large a new bureaucracy would have to be created.
I am in favor, though, of the government as a payer of last resort for those who cannot get coverage and those for whom treatment is too expensive for the insurer.
We need to regulate medicine and to take the uncertainty out of it. That uncertainty extends from patients who never know when they will be sideswiped by an out-of-network procedure and routine providers, to the hospitals that need to know what they will be paid. Coverage should be guaranteed, not negotiated.
I used to own a newsletter publishing and conference company in Washington. I provided health insurance, which cost me in well-being as well as dollars. The costs went up relentlessly and coverage was problematic. My top aide came down with a rare cancer. The treatment was fine, all paid for, but the post-treatment painkillers were not allowed. I tried to persuade the insurer — after all, we were a 20-strong group. They would not be moved. So my aide, who is French, had her sister send the medications from France, where she could get them for free as a citizen.
If we can get the horror of negotiation out of the system, care would be better, and costs would fall.
I am told the future might be based on what already is working well with Kaiser Permanente, an integrated managed care consortium that insures, provides doctors and hospitals in the package.
It is worth a look — before we start shelling the system to save it.
