Wednesday, May 02, 2012

from The Health Care Debate: Is It Possible to Reach Conclusions That Are Satisfactory?

by John Shelby Spong

The argument before the Supreme Court as to whether the Federal government can mandate health insurance for all citizens represents a fascinating dance around shifting realities.  It is an argument that totters between the values inherent in an interdependent society and those cherished by an individualistic society.  The reality is, however, that in an ever-shrinking world, individuals are of necessity interdependent.  There is no such thing as pure individualism in an interdependent world.

My point is that if we are to mandate that hospitals be required to treat any patient who shows up on its doorstep then we are also mandating that those costs will ultimately be borne by taxpayers and those who do have health insurance, so the issue before the Court has already been decided.  We have already accepted the principle that health care is a basic right and must be universally offered and paid for by the whole society.

In an article published in the Journal of American Medical Associations in March of 2012, Dr. David Naylor and Ms. Karline Naylor proposed seven proactive principles for health care reform in America.  They are realistic, but they also make it clear that some of the problems we face will never be solved by political rhetoric.

Their first principle was to recognize that there is no perfect health care system.  Every system balances availability against affordability and quality.

The second principle was that every nation must recognize that it must adapt health care to its own constituency, but there is wisdom in adopting things that have worked well in other nations without the ideological bias that so often accompanies the health care debate.

Third, in designing national health care programs, simplicity always trumps complexity. The more changes a program initiates the greater the risk of unintended consequences.

Fourth, we will all need to face the fact that every health care bill has limits and engages in rationing health care services.  The question is who will make the decision on who gets what care.  In a single payer system, a single authority usually makes that decision.  In the more complex American system, those decisions are made by many people on many different levels.  The myth is that there is no rationing.  In no system are all conditions covered.  It is, however, far more expensive, more difficult and politically more compromised to make it on local levels.

Fifth, every system is designed to achieve fairness and all promise to deliver fairness, but no one is yet able to define what fairness means or to describe how it looks.

Sixth, there appears to be little correlation between the amount of spending and the quality of health care that is provided. America’s heath care costs per capita are the highest in the developed world while America’s health care falls far short of being the best for all its citizens by almost every objective statistical measure.

Seventh, micromanagement has been demonstrated not to be optimal whether the system is administered by public or private agencies.

These are some of the reasons that healthcare seems intractable and remains polarizing. It is an area of life in which every citizen has a significant vested interest and in which other clearly identified constituencies like doctors, lawyers and insurance companies conduct active and well financed lobbying efforts to protect their profits.

I am still convinced that a single payer universal national health service is both inevitable and, in the last analysis, the best system for the vast majority of our people.  Before this nation arrives at that, however, we must stagger over the terrain and live with mistakes and shortcomings and the issue will be political red meat for years to come.


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