Have we turned a corner without knowing it?
Have we turned a corner without knowing it? Has the atmosphere changed just a little in the seemingly endless debate about healthcare in our country and how to pay for it? Lately, especially during the recent election, everybody in the news has suddenly seemed to want protection for coverage of preexisting conditions, even folks running for office in Missouri, Florida and elsewhere who had joined a lawsuit to get rid of that very same protection as part of the Affordable Care Act. Was that just election fever, a sudden onset of compassion for the sick and potentially uninsured, or did it mirror a subtle but significant change in the national mood?
Statistics do seem to back up this intuition on the subject of preexisting conditions. In a recent Kaiser Family Foundation poll (September 5, 2018), 75% of those surveyed wanted to keep the provisions of the ACA that make it illegal for companies to deny coverage to those with preexisting conditions. 72% favored keeping provisions that make it illegal to charge sick people more. Back in the day, before the ACA, you will remember it was perfectly legal—just good business—to deny people insurance because they were sick, or to drop them when they got sick.
Have Americans finally come around to the idea that people really do need health insurance, especially when they are sick? Are they ready to accept the idea that government may have a role to play in guaranteeing access to that coverage? Not sayin’ whatrole, just sayin’ arole. Are they ready to acknowledge that if it’s good for one American family—theirs-- it’s likely good for all American families? Are they ready to get behind that whole love of neighbor thing and make it a matter of policy and law—or not?
We really have made some significant progress in recent years and most people know it in their personal lives even though it may not be expressed openly in their political opinions. In states like Pennsylvania where Governor Wolf expanded Medicaid after the coming of the Affordable Care Act, we are down to about 5% without insurance from a starting point of about 10% (15% nationally) without insurance ten years ago. That’s progress. On the other hand, small business people and self-employed entrepreneurs who earn more than the limit for subsidies are often forced to pay outrageous premiums if they purchase insurance on the exchanges. They are right to be angry. Big institutions, for their part, are often experiencing double digit increases in their costs year to year, and their HR people are right to feel a little bewildered as well.
The truth is we have a fragmented system that ends up costing us significantly more than what we might pay in a fully integrated, well-administered system. Most of us get by, but some still don’t. And since the system fails us one at a time, leaving a single individual or family in crisis, it’s been hard to mobilize the political will to fix the problem. Churches can help, neighbors can lend a hand, but a family without insurance is all too often simply on its own when it comes to paying the bills.
True, many feel we don’t have a fully developed solution yet to this important problem, at least not one we can all agree on. But could it be time to think together about the values that should be embodied in a reformed American healthcare system? Might it be time for dialogue about the principles that should guide us as we try to fix what’s broken in our approach to paying for care?
Here are five values we should take seriously:
Transparency: We’re not going anywhere without greater transparency. Have you tried to read a medical bill or insurance policy lately? Have you been curious why a procedure or drug cost so much? Sunshine is hard on germs but also on the many forms of deal cutting and profit seeking that make our healthcare the most expensive in the world. In order to protect ourselves, our families, and our communities, we need to be able to see what’s going on.
Personal Responsibility: Conservatives often point out that as patients we need to take more responsibility for our own health, and they’re right. Much illness could be eliminated or reduced and dealt with more cheaply by maintaining a healthy diet, exercising, completing a regimen by following the doctor’s order. We need to support personal responsibility and expect it from ourselves.
Organizational Accountability: Government and private enterprise, hospitals, doctors, drug and insurance companies, all need to be held accountable to the people they serve. The drive for profit may, in fact, need to be tamed a little by regulation at times, but our regulations should be intelligent and nimble and prove themselves over time by actually working to deliver the intended results. And revised if they are not working.
Universality: everybody covered, nobody left out. It sounds like the right thing to do. But universality can also save us money. Imagine, instead of twenty sets of rules, one set for insurance companies and doctors to follow. Imagine the money that could be saved by consolidating administrative staff and redundant services. A fragmented system—like ours—is an expensive system. Almost all other industrialized countries around the world have taken advantage of the savings that come with an integrated, universal system of one sort or another. Why don’t we?
Dialogue: Is it possible to hope for real dialogue as we move forward on healthcare? The last time around, as Congress labored over the Affordable Care Act, not everyone with a stake in the issue was allowed a seat at the table. Lobbyists and special interests more or less ran the show. The right to purchase a so-called public option, a Medicare-like plan offered on the insurance exchanges alongside private plans, had to be sacrificed to get something through a divided Congress. There were people sitting around a table but there was no dialogue, not really.
Maybe the best we can hope for right now is conversation: one Liberal, one Conservative, one conversation at a time.
Will Lane, Chair
Gettysburg Democracy for America