Healthcare not black and white

As I write this column, I am glancing sideways at the editorial cartoon on the opinion page in the February 27, 2019, Gettysburg Times.  For those who missed it, it depicts a smiling Senator Bernie Sanders driving a forklift. The forklift carries a statue of Karl Marx, and Senator Sanders is about to deposit it in front of the U. S. Capitol building.

I don’t think Senator Sanders has all the right answers to the many challenges that anyone trying to repair our broken health care system will have to address.  Neither, I think, does anybody else.  But implying that Bernie’s proposals are communism in disguise is not going to get us any closer to the answers we need.  Every other highly industrialized country on earth has faced those challenges, and for the most part they’ve all found answers that suit their unique history and culture.  Some of them, like England, have opted for a single-payer system.  Others, like Germany, have opted for many payers.

What they have in common is this:  it took a long, deliberate, usually contentious process for them to arrive at a solution.  And so far as we can tell, most of their citizens are satisfied with that solution. Here in the U. S., we’ve barely begun that process, and too many of us still haven’t gotten beyond name-calling. 

Let me highlight just one of the many places our present system appears to be broken:  who should assume the cost of training future physicians?  When you add up the cost a prospective doctor must pay for her years of undergraduate education and medical school, the total amount is enormous. All but the very wealthy have to take out large personal loans.  To repay those loans once they graduate, doctors need to make money, a lot of money.  It should not surprise us, then, that many opt for highly-paid specialties like surgery or cardiology rather than becoming the general practitioners that many sections of this country so badly need.  Students from lower-income backgrounds, no matter how talented, often choose other professions rather than face the long, expensive process of becoming a physician.

There’s no obvious “red” or “blue,” “socialist” or “capitalist” set of solutions to this problem.  The sensible thing, it seems to me and many others, would be to put all the options on the table and choose the ones that show the most promise. Fortunately, our fellow industrialized countries have a lot of experience from which we could draw.   Some attack this problem by providing free or very-low-cost higher education.  Future doctors still have to invest years of their lives to obtain a license to practice medicine, but they don’t graduate with enormous debt.  Others provide bonuses or other financial incentives for doctors willing to practice in parts of the country where physicians are in short supply. (Some American municipalities, states, and even the federal government have experimented with this, too.)   More robust scholarship programs, funded either by government or by private foundations, offer another possibility.  We will want to look at all of these options, and there are surely more. Maybe we’ve been slower than neighboring countries to make sure everybody has access to affordable, high quality health care, but at least we have the opportunity to learn from their successes and failures.  

As one Democratic candidate among more than a dozen others, Senator Sanders will be laying out what he sees to be the major health care challenges this country faces and explaining how the solutions he proposes will address those challenges.  His competitors will do the same.  Perhaps, after two years of discontent with the Affordable Care Act, Republican congressional candidates will also have new solutions to offer.  After virtually ignoring health care until the 2018 mid-term elections, the news media seem finally to have decided that health care is a subject deserving of their coverage.  If we do our homework, we citizens should have an unusual chance to learn about the health care choices we face and to make our positions known to candidates.

Or, we could act like editorial cartoonists and think of health care proposals as either good or bad, black or white, red or blue.  This isn’t what the Founders of this country expected of us, but it’s all too often how we tend to behave.  

Baird Tipson is a member of Gettysburg Democracy for America’s Healthcare Task Force.