Overhauling the Debate Over Health Care

The Supreme Court cannot fix healthcare, and U.S. political parties will need to give up some cherished ideas if we are to stop the runaway train that is health-care spending.

My fellow Republicans need to understand that universal health care is not a right but a good financial and societal decision. People should not be deterred from leaving their jobs to start new businesses because they may lose health-care coverage, and workers should not have to worry about how to pay for coverage.

Democrats need to understand that we are in a capitalist society and that, like the stratification that exists everywhere in our society, health care cannot be the lone exception. Today, different levels of health care are available to the population. Acknowledging this does not make us bad people.

The underlying problem is that we want more health care, regardless of efficacy. Moral hazard exacerbates our health-care situation because we do not pay for care directly and often do not know how much was paid on our behalf. Our ignorance of the true cost of care has led to higher than necessary administrative costs, a bias toward action and more of everything. After all, if a $1,000 test could be provided for by a $25 copay then why wouldn’t you get it?

We need a single-payer, basic health-care plan that covers a prescribed set of conditions. We need to allow people the option of “buying up” for supplemental coverage and to be cost neutral by utilizing only the current funding supplied by the government, employers and employees.

The government correctly aspires to improve the health status of its citizens, but it is making things worse by trying to patch our current hemorrhaging health system.

A single-payer health system will significantly reduce administrative costs (which are currently 4 percent to 8 percent for Medicare and 12 percent to 20 percent for commercial payers) and billing costs. A group from Cornell estimates savings could be $27.6 billion annually. A single-payer system will also increase negotiating power for pharmaceuticals, which cost more in the United States than anywhere else. One payment mechanism could also highlight the costs of our medical-care decisions and allow us to make budgetary as well as clinical decisions about what services should and should not be provided.

The current financing mechanism of paying for doing rather than for results encourages providers to do more and patients to request more. The solution is to reduce variability and provide only appropriate care. Deciding what to cover within budgetary constraints will include controversial things such as transplants, IVF and heroic measures for preemies. Raising budgetary concerns on what care to provide is an emotionally charged issue, but it is better for a physicians committee to recommend solutions than for solutions to be the unintended consequences of the way the system works today. If people are concerned about appropriate representation in these decisions, one possible solution would be to have each House representative nominate one physician to form that committee.

Health-care cost is a major concern. Let’s address it in a rational nonpartisan way.

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