One of the reasons that services such as healthcare are hard to reform in a political context is that politicians feel they need to produce quick results for the electorate. This political fact always gets in the way of producing long-term workable solutions. Change in large systems does not occur overnight. Nor does it occur within a four year presidential term. Unfortunately, appropriate solutions are frequently overlooked so that measurable, but inappropriate, progress can be shown to voters.
Healthcare delivery is not the same as producing cars on a production line. You can’t shut down the delivery pathway, retool and prepare for a new model in the same way that Ford or GM would do in one of their plants. Also, the very nature of health care being delivered at a local level to defined and small group of the population makes it incredibly difficult to standardize all aspects of that patient pathway. This inherent flaw produces in places such as the United Kingdom a postcode, or in the United States a zip code, lottery in terms of the quality and quantity of healthcare delivery.
In the United Kingdom there are measurable differences between differing geographic areas and the quality of the health care they provide. There is also measurable differences in the way that those areas ration healthcare based primarily on budget constraints and not necessarily efficacy or clinical need.
In single-payer systems there is also the issue of the two-tiered provision system. You can see this in both the Canadian and UK systems. In the case of Canada many thousands of people who paid for their healthcare through the national health care tax, seek routine care that they have to pay for themselves across the border in the United States. They pay for that care twice. It could be argued that if they had waited the one or two years that is required to access certain procedures then they would’ve avoided this unnecessary expense. In the UK you see private provision sitting adjacent to national health service facilities. As I’ve outlined in previous posts the people who provide services in the private facilities are the same people that provide the services and the NHS. Again, people who have the disposable income to jump the line by paying for private procedure can have any, hip or cataract procedure done in a matter of weeks and not months.
This begs the question; are we prepared to replace one two-tiered system with another? Interestingly, the replacement will flip on its head the perceived inequality that currently exists in the United States. What we will have is a system where the very rich will exist outside of a government-sponsored, run and provision health system, and the majority will be forced to accept a lower standard of care than they were used to in the past.
The debate until now, has centered around the overall cost of health care. I hear little about what the contribution of our health system is the country’s GDP. I also, and I suspect the politicians don’t understand it either, don’t have a clear view as to what the national clampdown on health spending will do to the real economy.
Political expediency is a dangerous phenomenon. Near-term decisions are made about long-term needs. I’m not suggesting that changes in policy and the reforming of systems by politicians is done cynically and only for political gain; but the reality is their world is one where quick wins and the appearance of making a difference is far more important than creating a long-term and sustainable program of reform.
In the United States we tend to avoid severely polarized politics. In the United Kingdom change of government has typically meant that the new incoming government completely dismantles the reforms of the previous one. Therefore, change, or the lack of change, centers around superficial and cosmetic attempts to affect reform. It would appear however, that the United States Congress has never been more polarized on the issues. If one thinks back to 1994 and Hillary Clinton juggernaut that was bearing down on the health system at the beginning of Bill Clinton’s presidency, drawing comparisons to the Obama plan are hard to avoid. You have an administration who is dedicated to reforming the system, not only a reform, but a complete change in the way that health has been delivered and paid for in the United States. Without dialogue and providing salient argument around why such a wholesale change to the most personal of all services provided to voters is needed, Government will only ever fail to carry the day.
Partisan politics is not a good foundation for change in such a sensitive area. Neither is a highly skeptical and worried, if not scared, population. The new president has embarked upon a journey and appears to have left behind him the majority of the American population. Until there is a coherent argument and a well thought out plan as to how and why a system, however flawed, must be changed to the extent that he is suggesting currently, I can only see failure in his future.
Americans have every right to be skeptical of the proposed changes. You can look around the world compare our system with others and yet, if you are seriously ill whether insured or not, the United States still remains the best place to receive care. In Other government controlled health systems, waiting for care or the inability to access that care kills people. If you look around the world you don’t see foreigners, unless they are poor, flocking to European publicly delivered health systems. What you do see are are people attending the private clinics of London, Berlin, Zürich, and those of the United States.
I’m not sure if there is a specific solution to the “crisis” in American health delivery. I’m also unsure as to the extent of the crisis. The noise around the overall cost of the delivery of healthcare in the United States is always loudest during economic downturns. The American system covers its citizens through insurance products that are primarily paid for by business, and understandably businesses when times are bad are looking at ways of cutting costs. Business however should be very careful around the current suggestions for the reform of the system as this will only add significantly to their tax burden. As I’ve said before, to suggest that the government will be a better steward of health delivery then insurance companies is folly and a lie. What we will end up doing is creating many further layers of bureaucracy which will only add to cost, it will erode access, it will impact adversely quality, and most importantly it will put into government hands one of the largest industry in the United States.
Filed under: Government Policy , big government, cost, government, healthcare policy, healthcare quality, healthcare reform, innovation, intervention, nationalized healthcare, obama, rationed care, rationed healthcare, underinsured, uninsured
