U.S. Health Care System, Government vs. Market Reform - Why American Health Care Reform is So Hard

I’ve been writing about American health reform for 30 years. It never gets any easier.


I started in the 1970s when HMOs bloomed in Minnesota, thanks to Paul Ellwood. Ellwood convinced Preside Nixon HMOs were the thing. . In 1973 the HMO act was born. The pace accelerated in 1976 when I attended an 8 week course on Health System Management at Harvard Business School. A single payer system seemed imminent, and Senator Edward Kennedy got government money to support the course so Harvard could meet the major players in the new system.. But reform was not to be. In 2005 I interviewed 42 national authorities for my book Voices of Health Reform. I concluded health care gridlock would continue because reform always geared someone else’s ox.


Health reform is hard for many reasons. We distrust centralized government. We believe in equal opportunity not equal results. We think the majority rules even though minorities may suffer. We see freedom of choice and access as God-given rights. No “socialized medicine,” rationing or queuing for us. We’re not a cruel people. We just don’t believe government is the answer. Markets and self reliance are.


We’re a vast continental nation with vast regional differences, but our reform ideas tend to be half-vast. We have a mixed population of 300 million. Our people include 31 million recent immigrants with different cultural expectations. This creates barriers and confusion. We have a history of individualism. Our Wild-West mentality creates the illusion that all things are soluble as long as we move to the horizon and seek new frontiers of cure.


We all hold strong ideas of what health care should be, especially when someone else pays for it. Given this sense of entitlement, we expect, even demand, the health care we think we need. Damn the expense.


We yearn for a political savior, but there is no savior. The problem is bigger than politics. It’s being hooked on technology, behaving as we please, rushing to satiate to relieve anxiety and stress, riding rather than walking, believing vitamins, immune system builders, herbs, hormones, and other nostrums will do the trick, and, if all else fails, turning to specialists for a quick fix.


We see the body as a machine. If the machine’s face or frontal knobs sag, lift them; if pipes plug, bypass them or put in Drano; if joints wear out, replace them; if organs fail, cannibalize other machines for substitutes. Stress body owner’s manuals, artificial hearts and parts, and mechanical devices. We can’t replace one organ , but we’ve got Al (Algorithm) and Art (Artificial Intelligence) working on it.


We’re opportunists. Lift ourselves by our own bootstraps. Talk of safety nets, as if life were a high-wire act, but don’t dig too deep in our own pockets to pay taxes to weave new nets or to sew up holes in old ones.


We’re capitalists. Solve problems by letting markets reign. Let Big Management and Big Ideas solve social problems. In the end, blame Big Government. But distrust Big Government. As a conservative society, we suspect no nation can support a robust growing economic and a generous welfare state at the same time. We cite Europe as an example. Health costs for Europe’s aging peoples are growing as fast or even faster than ours. Their economic growth has been half ours over the last 25 years. Their unemployment is twice ours over the same period.


These are some of the reasons health reform is so hard. Meanwhile, until reform comes, we’re living longer. Deaths from cancer, heart disease, and stroke, and our cholesterols, are dropping. Things could be better, but we’re getting healthier every day even without reform. So don’t despair. Hang in there. Americans and their doctors are doing something right.