The Health Care Crisis

The uninsured population of the United States has perplexed our country and our leaders for several decades now. Many have termed this our national health care crisis, but it is not nearly as much a health care crisis as a health insurance crises. As medicine has gotten more technical and expensive, the affordability and availability of insurance has gone down. Health insurance affects our society in many different ways including cost shifting, job decisions, and actual availability of health care.

How we got to where we are is complicated and there are no easy answers as to how we can correct our problems. Opinions are very polarized as to whether or not national health insurance will correct all our problems, but the question is really not that easy. At the same time that many countries with national health insurance are trying to privatize large sections of the healthcare, we are trying to experiment with a whole new tax and guaranteed health care system.

As we taxpayers, patients, and citizens ponder this problem, we need to consider several different realities. Right now we pay 17% of our gross national product for healthcare. Everyone agrees that this is a substantial sum, but there is no agreement as to how to lower this amount while continuing to expand healthcare that is available today. Technology continues to increase not only the quality of care but the cost.

There are only two ways to ration healthcare or any other commodities; either the marketplace determines what is efficient, worthwhile and affordable, or the government creates an agency that artificially determines appropriate care and the appropriate reimbursement.

Neither method is perfect or a magic solution. Market based solutions can be inequitable, and government solutions can be very inefficient and even more cumbersome than the current disjointed private health insurance system.

I propose that we need to expand our thought process beyond just whether or not national health insurance is the problem. As a lifetime Republican voter I am personally very distrustful that a whole new government agency can be more efficient than a private health care system. After all, our military, post office and other governmental agencies are not exactly paragons of efficiency.

Two problems need to be addressed

1. Most of what has gotten us into the current state of affairs is the tax system. Fixing our tax system is more important than creating national health insurance. Right now most of us obtain our health insurance through our employer. If we leave our employer we no longer have health insurance. Any new system will have to make insurance owned by the employee and not the employer.
2. The next problem to solve is the fact that most patients who are not insured are so because they do not use much health care, whereas as we age we have a higher need for insurance and healthcare but can no longer afford the insurance. Insurance is designed to spread risk among many people and with 46-47 million uninsured people, the risk is spread right now only among a certain segment of the population. Any system that is designed needs to be all inclusive and compulsory for everyone.

If we could solve the two above problems we would be much closer to being able to provide for an equitable system that provides ownership in the health care system, and still allows patients flexibility in employment options. If congress cannot provide for a more reasonable tax system and more reasonable insurance options, then they will have to nationalize healthcare. However, if the politicians in this country cannot provide for reasonable playing field for a market based healthcare solution, I would be very dubious that they will have any really constructive or practical solutions as a government run agency.

Posted by: Peter Ullrich, MD