Wednesday, October 8, 2014

The Monday Morning Health System Quarterback

To begin, I hesitate to call the U.S. health case a “system.”

What we have is a pluralistic potpourri, part-government -run, part-privately-run, non-system presiding over health care in a vast continental multicultural nation with a population of roughly 320 million people.

The government pays directly for nearly one-third of us (50 million Medicare, 65 million Medicaid, 7 million VA, and others), and just over 50% depend of government benefits. Through its vaunted health reform law, government tries to fence in 100% of us through a combination of barbed wire (mandates) and bailing wire (regulations).

The intent of the government ruling party is noble (health care for all) and well-intentioned (all for one, one for all), but it has adverse consequences (unlimited government power and loss of individual freedoms), and it is extremely costly ( somewhere in the neighborhood of $1.5 trillion to $2.5 trillion over a ten year period, depending on who is doing the estimating).

The debate over where the “system” is headed boils down to clashes of -isms (socialism versus capitalism, collectivism versus individualism, elitism versus entrepreneurialism).

It also comes down to these questions:

Are we a center-right or a center-left nation?

Do we believe in equal opportunity or equal results?

Should wealth and health benefits be redistributed, and if so, how does this redistribution affect economic growth?

Which is more important – economic growth or social justice- and can we have both, or is it one or the other?

What should be the size of government?

Is the best government big government that governs most or small government that governs least?

Shall the system be more centralized in Washington, D.C., and more decentralized in the states?

Shifting Ground

While these issues are being debated and these questions are being raised, the ground is shifting under our feet.

Health care costs are being shifted from employers, who cover 150 million Americans, to employees.

Health care is shifting from individual doctors to large organizations like hospitals, health systems, and health plans.

Health care delivery is shifting from inpatient care to outpatient care.

Health care information sources are shifting to the Internet, to social media, and to big retail chains. Health care decision making is shifting from doctors to data.

Political power may be shifting from Democrats to Republicans, both at the state and federal levels.

People are shifting for themselves, with more alternative care, self-care, and home-care.

And some physicians are shifting to direct care, away from government, institutional, and insurer care.

While all of this shifting is going on, issues, costs and prices of health reform are becoming more transparent. The days of the health care quarterback sneak are over.

Thus, the people, the times, and the laws do shift. Where they stop will depend on the will, votes of the people, and actions of consumers in a consumer-based nation.

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