Universal health care

Over the last couple of weeks I’ve been taking a crash course in health care reform, and the more I look at this mess, the more I like the idea of universal health care. The outrageous cost of health care in the U.S. – coupled with mediocre results – make clear that we are fundamentally doing it wrong, and must have the humility for a dramatic change of course. Having a government or cooperative player competing in this market is likely to have some positive effects, but I don’t see how it is going to solve the problem.

The main problem seems to be money. We already spend 18% of our GDP on medical care, and that concentration of wealth leads to a concentration of power. It is not hard to see why Congress is not leaping to make change that threatens more than a sixth of the country’s lobbying power. But unless we can change the direction things are going, the obstacles to a real fix will become greater, as more and more of our money flows into the industry. If you haven’t already read it, Atul Gawande’s article on medical costs will give you the chills.

Anyone who has been following this blog knows that I’m a big fan of cooperative solutions, and philosophically inclined to avoid government solutions. But I’m also a big fan of realizing when co-ops are unlikely to succeed, and I think that health care might be a case where the situation has deteriorated to the point that anything less than a fresh start might be too little and too late.

The co-op plan and government plan both have their strengths and weaknesses, and each are currently so vague that it is hard to say which will work better. Unfortunately, it seems like both of these options are unlikely to address the cost issue and the lack of accountability in health care: As long as we are only creating a new insurer (rather than an integrated cooperative or public health system) we are missing the point where real change is needed. Models like Group Health and HealthPartners may save money and improve health due to their cooperative structure, but their main improvements come from providing medical care through their own clinics and salaried doctors.

It breaks my heart to admit it, but the ideal of setting up parallel cooperative systems is probably outside our reach at this time. That doesn’t mean that we should stop working toward that ideal; we just need to be very careful about skipping some key stages of development. One or more cooperatives could form the foundation for something that really challenges the status quo, and if the co-op plan is implemented I’ll do what I can to help in that regard. But it is not realistic to think that the government is going to just haul off and solve this problem through the creation of either sort of white-hat competitor in the insurance field.

Even The Economist seems to be coming around to a public plan, beginning its latest discussion of solutions like so: “If he were starting from scratch, there would be a strong case (even to a newspaper as economically liberal as this one) for a system based mostly around publicly funded health care. But America is not starting from scratch, and none of the plans in Congress shows an appetite for such a European solution.”

When The Economist’s main argument against some form of universal health care is that we aren’t starting from scratch and Congress isn’t proposing a serious solution, you know there are some pretty severe problems with the current system. And that applies both to our health care system and our national system of governance.

President Obama recently offered a similar argument at a town hall meeting in Virginia: “This is one-sixth of our economy, and we’re not suddenly going to upend the system.”

That’s fine, and I agree that we need to find ways to move gradually through the wrenching changes that are needed. But the system is going to upend itself if we don’t get it out of this vicious cycle.