WWFD: What would the Founders do to fix American healthcare?
Our Founders loved ideas, but they were also practical people. They got stuff done. All you need do is crack open a copy of The Federalist Papers to get a whiff of Hamilton, Madison, and Jays’ love of words and ideas. Or, whip out your copy of the Constitution and take a look. The Founders’ practical side, of course, is evident all around us: a country that, despite some recent setbacks, has managed to survive as a functioning democracy for over 200 years. Wouldn’t it be something if we could bring their spirit of practical-problem solving to bear on the current crisis in American healthcare?
For the most part, this crisis is not about the quality of healthcare but rather about access and how we pay for the care we receive. In my own case, I likely would not be able to read the words on the screen as I type this article, at least not without difficulty, were it not for the almost magical surgery that has repaired retinal tears in both of my eyes. I wouldn’t be walking around much either without the hip replacement I now enjoy. I might create a stir at the airport or court house with that big hunk of steel in my hip, but as a person who had insurance when he needed it, I am a new man two or three times over and good to go, at least for now. The quality of our care is almost always world class.
The problem comes in paying for that care. Other industrialized democracies around the world have decided to provide healthcare coverage for everyone, and they have taken several, rather different approaches to getting that done. In the United States, however, we have decided not to decide, not to act in a decisive, coherent way, and have ended up with four or five different systems, depending on how you count: private insurance through employers for many; government-run Medicare for those over sixty-five; Medicaid for folks with low enough income; socialized medicine for our veterans through the VA; and an out-of-pocket non-system for all the rest. The result: we spend more per capita than any other nation but leave twenty-some million Americans without coverage and a much larger number underinsured.
How would the Founders deal with this very expensive, often annoying, and sometimes heartbreaking tangle of not-quite-half measures? First, I suspect, they would get clear about the goal. Secondly, they would take time to articulate the values that should guide their approach to achieving that goal.
If you take the tour of healthcare systems around the world with a writer like T.R. Reid in his classic study The Healing of America, you will learn that for all these countries the primary goal is not to provide a cash cow for pharmaceutical companies or to guarantee insurance execs multimillion dollar compensation packages or even to ensure every physician a seat behind the wheel of a Mercedes Benz or similar car of his or her dreams—rather the goal is to provide access to affordable, high-quality healthcare to every resident .
With that goal in mind, the question becomes how best to meet it, given the economy, culture, and traditions of the country involved. Though successful healthcare systems around the world range from Britain’s partly-socialized National Healthcare Service through Canada’s Medicare for All to the carefully- regulated, private but nonprofit approaches of Germany, Switzerland, France and Japan, they all are founded on four key values: partnership (between government and private enterprise); transparency (in terms of prices and procedures); accountability (of everyone involved); and universality (also known as inclusion—everybody in, nobody left out).
Why partnership? Well, frankly because unregulated private markets don’t work very well for delivering quality healthcare at an affordable price. There is a fundamental imbalance between patient and provider that prevents the market from functioning properly to create competition and limit costs. Try shopping for a better deal the next time you have a heart attack or suffer a serious accident and you’ll see what I mean.
As for transparency, have you looked at a medical bill recently, or made a call to try to clarify what it was saying? We need to know exactly what was done and how much it cost. In fact, before it’s done, and after we fully understand why it’s being done, we need to know exactly how much it’s going to cost. Transparency sets the stage for meaningful shopping when the healthcare problem involved allows for it. It also make accountability possible.
But accountability really must include everybody, us too. We’ve got to eat our veggies and take that walk around town. Yes, ease up on the Christmas cookies and get that colonoscopy, after all! But government, healthcare providers, insurance companies, and waiting rooms (with us in them) are all staffed by fallible—though usually well-intentioned—human beings. We are all in need of forgiveness, but accountability must come first.
Last but not least, comes universality or if you prefer, inclusion. On one level, it’s a moral question, love of neighbor and so forth. I should want for others what I want for myself and my family. But it turns out that—per capita—it’s also quite a bit cheaper to just go ahead and cover everybody. Check out any of the countries mentioned above—especially our mild-mannered neighbor to the north—and you’ll see the evidence is in. A coherent system with one set of rules, less paperwork, less bureaucracy, and an emphasis on affordable preventative care is both better and cheaper.
The next time you hear the pundits and politicians holding forth, don’t forget the big four: partnership, transparency, accountability and inclusion. Healthcare in America can be fixed, and with the help of our Founders and their spirit of practical problem solving we can get that done.