When reading writers who either support or oppose major changes in our health care system it is easy to assume that we are faced with a single mighty question…
How will we reform our health care system?
Will we wind up like Canada, or Britain or France or Zimbabwe?
The issue actually consists of two densely intertwined problems.
First, there is the money problem. Who, we are asked, will pay? How much will they pay? How much will people receive in return for what they pay?
The health care financing geeks (you gotta love ’em) have their own set of buzzwords and catch phrases…
access— A person’s ability to obtain affordable medical care on a timely basis.
beneficence— An ethical principle which, when applied to [health] care, states that each [patient] should be treated in a manner that respects his or her own goals and values.
no balance billing provision— A provider contract clause which states that the provider agrees to accept the amount the plan pays for medical services as payment in full and not to bill plan members for additional amounts (except for co-payments, coinsurance, and deductibles).
The morbidly obsessed can go here for thousands more examples of this kind of language.
The second major question concerns quality. These reformers are primarily concerned with the care that is actually being delivered. They want to know if that care is any good. Does it create outcomes that are better, or worse, for the people receiving that care. America spends, per capita, more for its health care than any other nation on earth and yet the outcomes created by this (very expensive) system are middling at best. America does not have, as is so often claimed, “the best health care on Earth.” Instead, we have the most expensive health care system on earth.
Real health care reform requires tackling the financing and the quality questions simultaneously.
So, as we hear more about the issue of health care reform, take note if the politician or expert you are listening too seems most concerned about quality or finance — a few of the best will be concerned about both issues.
One last note for now. We will also be hearing people claim that we will “be like” some other country. This is not true. Whatever kind of health care reform we wind up with (and I am hoping for the best) it will be distinctly American because it will evolve out of the current system.
This is the concept of “path dependence.”