Path Forward on Health Care

If one were tasked to design a health care delivery and financing system, with the goals of maximizing overall costs and minimizing efficiency, inserting as many layers as possible between the provider and patient, maximizing expense for those least able to pay, completely denying protection for those who need it most, and completely excluding over 15% of the population—while maximizing the power of, and the profits extracted by inert middlemen, who play no role in treatment of disease of injury—it would be difficult to improve upon the system we have today in The United States.

If the exclusion of millions of our citizens from health insurance coverage were necessary to maintain an economically efficient overall system, it would still be ethically unacceptable, but might be justified from a purely economic morally indifferent perspective.

Fortunately, we don’t face that conundrum. The same dynamics in our system which make coverage unavailable to millions of Americans, and prohibitively expensive for millions more, also add tremendously to the overall costs to our society.

We don’t even need to invent a solution from scratch. We are surrounded by countries with systems that work – societies that have advanced beyond letting for-profit health insurance companies pick the pockets of their citizens. None of these countries pay anywhere near what we do for coverage, none discriminates against low-income workers, small businesses and entrepreneurs, or the unemployed; and thirty-seven of them have broadly superior public health outcomes. Many of these other systems give consumers a much wider range of choices than most Americans enjoy. And none has anywhere near the US bankruptcy rate, the vast plurality of cases of which result from uncovered medical expenses.