The health care debate rages on.
Atul Gawande, one of my favorite physician-authors, wrote an article on this topic last week in The New Yorker magazine.
He spoke to residents in his home state of Ohio and posed the question, “Is health care a right or a privilege?” He listened to their stories of unexpected illness, lost jobs and medical bankruptcy. Yet none of them thought their health insurance should be free—just fair and affordable.
In our current crazy quilt system, those who do best are the very poor and the very rich. The majority of us, myself included, are stuck with ever-increasing premiums and deductibles and shrinking provider networks. For some, the cost of a cancer diagnosis or a trip to the emergency room for appendicitis or a broken arm is an anxiety that keeps them up at night.
Uncertainty and fear over health care expenses can ruin a family’s quality of life. Even those with insurance!
Health care, Dr. Gawande argues, might not be a right, but it’s a basic service for a well-functioning society. Like education, law enforcement and garbage collection.
Do people have a right to trash pickup? It seemed odd to say so, and largely irrelevant. The key point was that these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down. And that’s what has happened with American health care.
We’ve had to stitch together different rules and systems…and the result is an unholy, expensive mess that leaves millions unprotected.
It makes me crazy when I think of how much money is being spent on health care in this country. And the emotional toll is high, as well.
It doesn’t have to be this way.
Other countries have developed hybrid health insurance systems that involve the government, employers and individuals. In other words, “a collective effort and shared costs.” Although different, most offer almost universal coverage, provide better health outcomes and are more affordable and fair.
For more information about these other systems, check out this article in The New York Times. They recently published a fun health care “battle” to highlight the strengths and weaknesses of health care systems in 8 major countries: the US, the UK, Canada, Australia, Singapore, Germany, Switzerland and France.
To nobody’s surprise, the United States could do better at balancing health care costs with access, quality and outcomes. But there are many ways to reach that goal, and there will always be trade-offs. Learning about them from other systems and debating them honestly would probably do us a lot of good.
We can do better. We have to do better.
I’ve never been a huge fan of the Affordable Care Act, but I wasn’t happy with all the “Repeal and Replace” plans, either.
Our elected leaders need to be encouraged to work together to craft a fair, sustainable and affordable health care system that works for us.
Can they put aside partisan politics and special interests? I sure hope so.
More books by the awesome Atul Gawande: