Healthcare will be complicated as long as our nation fails to place a value on our citizens and entitled others’ ability to receive the healthcare they need in a therapeutically timely way.
Our national history of providing healthcare weighs heavily on any opportunity to extend coverage and lower cost. We lean heavily on a system of covering healthcare through an employee benefit called health insurance that began when employers were looking for a way to satisfy workers without busting the budget by increasing wages.
Fast forward to the 1960s when old people, who were now living longer, couldn’t afford health insurance and were going without. Older, sicker patients were more than voluntary services could handle. Despite strong opposition, the nation concluded that old people could not be left to die.
Medicare was born to provide a government-sponsored insurance program to people 65 years and older. The program was financed through payroll deductions and an imaginative system of care delivery that reduced dependence on expensive hospital care. Skilled nursing facilities and home health services were designed to provide an appropriate level and type of service to rehabilitate old people at a slower pace.
Medicare has gone through many revisions to control costs but Congress also added services such as hospice care, drug coverage and multiple services resulting from revolutions in diagnosis and treatment.
A similar government program called Medicaid evolved to insure healthcare for the poor, especially poor children.
Fast forward to the present and the myriad of systems for financing healthcare is busting the budget of the country, businesses, providers and families.
Soaring cost of healthcare
Access to healthcare seemed to be going smoothly until the cost of healthcare escalated; in fact, in some areas like pharmaceuticals, exploded. Medicare instituted more cost reductions; Medicaid became stingier. Employers began to balk as the cost of insurance as benefit costs soared and sought ways to reduce the cost to business such as having employees take on part of the cost.
The private market became costlier with increasing premiums, deductibles and co-payments. Catastrophic care coverage was the most that many could afford through the private market. And that was before the Affordable Care Act (ACA), also known as Obamacare.
Everyone was running from the high cost of health. Employers sacrificed generous healthcare insurance benefits or in some cases, removed it as a benefit. The government was very nervous about its inability to control the rise of healthcare costs and the impact on the federal debt. Individuals either stayed anchored to their employer or went without insurance.
The ACA was heralded as the next big healthcare movement that would deal with an old-fashioned fee for service system, bend the cost curve, save money on the very sick by prevention and extending healthcare insurance to millions stranded between systems.
Repealing healthcare as national value
The ACA launched but never escaped strong, relentless and very vocal opposing forces. Some claim that the Republican Party is in total control of the government due to the public’s desire to repeal the ACA.
Yet, the party itself was unable to come to terms with repealing the entire act as promised. Seems that stranding millions of people without healthcare was distasteful enough to some party members that the terms are still being negotiated.
The party’s internal division illustrates the issues driving our nation’s ambivalence toward the role of government in healthcare.
Among the primary issues are the degree of government control, particularly that of the federal government, over the provision of healthcare, and the escalating cost of healthcare and resulting burden on our economy.
Despite worries over government control, I have yet to hear an elected official propose the elimination of Medicare.
Those that oppose Medicare as a government insurance program propose a voucher system that they say will reduce costs due to market forces.
The primary problem with leaving healthcare to the market identified by people far smarter than me is that people faced with serious illness typically don’t shop around, mostly due to a lack of expertise and resulting dependence on their healthcare providers. That’s just not going to change.
Moreover, if the voucher is to purchase healthcare insurance, the same individual decision-making process that occurs now with the drug plan and the ACA will occur. Well people will get less insurance and sick people will get more, resulting in the chronic insurance provider nightmare of maintaining a balanced risk pool.
Underlying the debate is the unspoken belief of strong opponents that the individual is responsible to care for himself, herself and any offspring or said another way, the sense of resentment felt over paying taxes to support the healthcare of others viewed as less responsible.
Little daylight exists between paying healthcare taxes and paying health insurance premiums in the sense that some people benefit more than others. People who get seriously sick or injured benefit because they need more.
People whose house is damaged from fire benefit more from having fire insurance. People who live in a flood zone are denied insurance because they are high risk.
Does it follow that people who have cancer and require expensive drugs are denied insurance because they are high risk? Does it follow that healthcare insurance providers don’t want to contaminate their risk pools?
Does it follow that 80-year-olds with several chronic disease diagnoses or the child born with a heart defect cannot afford or is denied insurance; better said, healthcare because they are high risk? Is that OK with you?
Risk pool management is after all what drives the cost and limitations of insurance. National health care would form an enormous risk pool that lowers the risk and cost.
What we’re doing is not working. We struggle too much to make a free market insurance system work.
The uncomplicated question
People often pose the question of whether healthcare is a right or a privilege. Neither is the question or the answer. Healthcare is a need and we happen to live in a country with enough smarts to figure how to deliver it without busting everyone’s budget.
The important question is whether having healthcare for each of us when needed is a value of this nation. Of course, I run in circles where it is a value because we’ve seen much unnecessary anxiety and suffering.
I fear there are others who never ponder the fate of people who are seriously ill or injured and cannot get treatment.
Some may be comforted by the false notion that hospitals must treat anyone who shows up in an emergency department, but emergency departments don’t plan for cancer care or provide rehabilitation therapy or dispense 90 day supplies of heart medication.
Saying that the market cares about the health of people is either wishful thinking or willful deceit. An honest debate would be around whether healthcare for all is or should be an unquestioned national value. It’s not that complicated.
More food for thought on this from the League of Women Voters/Clallam County who is sponsoring showings of “Fix it: Healthcare at the Tipping Point,” and “Now Is the Time,” films discussing our healthcare issues and solutions. See the box on page A-10 for date, time and place.
Bertha D. Cooper is retired from a 40-plus year career as a health care administrator focusing on the delivery system as a whole. She still does occasional consulting. She is a featured columnist at the Sequim Gazette. Reach her at firstname.lastname@example.org.