On June 30, Washington Public Campaigns sponsored a public forum on achieving health care for all. Panelists included a public health academic, a community health representative, a labor union leader, a citizen activist, a state legislator, and a public campaign finance activist. The program will be broadcast at some point on the Seattle Channel. Here are some highlights.
We spend $2.3 trillion on health care: every single $ is someone's income. For affordable health care, health care providers/vendors are going to have to make less. In other western countries, health care systems have two common characteristics: (1) they insure everyone, no exceptions, and (2) the government controls most of the money going into the system. In contrast, in this country, (1) not everyone is covered, and (2) thousands of different entities have a piece of the pie, are accountable only to themselves, not to the system, and therefore can simply pass the problems on to others. The current system allows people to make money, but is not so good for patients.
Community health centers are part of the solution. Massachusetts' experience, however, shows there are not enough primary care physicians. Congress seems to recognize this. Each proposal being considered contains incentives for medical students to go into primary care.
The union leadership is more liberal than the membership. Although costly health care takes away from wages, the average rank 'n' file person doesn't see any immediate problems with the current system. Union members are often worried about such things as socialism, lack of choice, etc. They are threatened by change. Consequently, the AFL-CIO can't support a single payer system right now. The union is against taxing of benefits. Leadership's goal is to convince the rank 'n' file that the public option will help others that they know. The public option is the way to eventual single payer.
Even the best care scenario for the public option will save only 9% compared to single payer. The typical mindset of opponents to reform falls within one of 3 categories (1) the independent/self-reliant person: I can take care of myself and don't need anything from anybody and don't need to help anybody; (2) the personal responsibility person: I take good care of myself and don't have to worry about health care; and (3) the entreprenuer: health care should be run like every other business in the marketplace. To convince people to get over their fears, they have to be persuaded to view health care as public goods (for example, police, fire, and library services) as opposed to market goods.
Public financing of election campaigns is critical.
We are paying 50% more in health care costs than the next most expensive system. Our system pays for episodes, not for health care. For example, ever wonder why hospitals release patients so soon? Because the payment system encourages it and then if the patient gets worse because he or she was released too soon, the hospital gets paid again. The pending proposals contain the "bundling" concept in which providers would not be paid on a fee for service basis, but on a fee for outcome.
But how do we end up with a uniform payment system that pays for "health care." Over the years, many have tried, but they have never gained traction on a widespread basis.
The system is rife with inefficiencies but not because of overhead. Rather, because ndividuals want the best health care possible and so they want every test, every examination. People are not interested in managed care.
We have to stop treating health care as a commodity that is part of the market economy.
