The King Has No Clothes

The way we finance healthcare does not work well for all American's because it's not a system that was designed to work for all Americans. This is evident in the plethora of health plans, some large, some small, most group plans, but with a few individual plans, most private, several government-sponsored, with different eligibility requirements, different benefits, different waiting periods and exclusions, widely different administrative expenses, ranging from less than the four percent spent to administer Medicare, to the 30 percent of premium spent to administer an individual health plan. Despite decades of lip-service to the concept that healthcare in America is a right, we still have no universal plan to guarantee the financial protection needed to make that right a reality.

The public/private system that has evolved to finance health care is not the result of the best minds in America planning thoughtfully for the needs of all of the American people. It is largely an accident of history, where each step has been taken to address some subset of the population: The poor and the elderly in the mid-60's; those who are between jobs in the mid 80's; uninsured children in the mid-90s, prescription drugs for the elderly in 2003.

All over the world, people get sick, see doctors and spend time in hospitals. Throughout the world, the problem of paying for this care has been considered, and in country after country this universal human need has been addressed by assigning the responsibility to government, which is in the best position to spread the costs fairly, provide access to all, and protect the most vulnerable.

In America, we have not taken the time to plan for our health insurance needs. Instead, we have allowed a patchwork system to evolve. Every day we are distracted by proposed treatments that address one or more of the symptoms caused by our underlying failure to plan. We have spent so much energy in this frenetic activity over the past three generations, that we see this as normal, as a productive use of our time and energies.

We have 46.3 million Americans without any health insurance, up from 30 million in 1990. So we tinker at the fringes, expanding a government program, or proposing legislation that would require employers to offer affordable health insurance to all their employees, or pay into a fund that would provide coverage to their uninsured workers. All the while, we hope these efforts will help to reduce the number without insurance. But if they did, we would be settling for less than what we need. It would be more effective to recognize that any patchwork of plans which was developed to cover only a subset of the population will never be effective at covering all of us. Our energies would be more productively spent developing a plan to provide coverage for every American.

We see neighbors in our own communities who struggle to pay the costs for the medical care they need because they are uninsured or underinsured. Through generous and creative efforts, we raise funds on their behalf by passing the hat at work, or donating unused vacation time. We hold spaghetti dinners at church, sponsor garage sales or arrange walkathons. We drop spare change into the jar at the coffee shop to help pay for a kid's cancer treatment. That wonderful American value of helping a neighbor in need often makes a huge difference for our neighbor's suffering today. But it does nothing to prevent that same suffering from visiting us, or another neighbor, tomorrow. If we turned those same creative energies to work on the real problem, rather than its symptoms, we would build a healthcare financing system that would protect all Americans today and tomorrow.

We complain about rising healthcare costs. We watch as additional Americans lose their coverage or struggle to keep up with rising premiums, deductibles and copayments. We stand by as the competitive position of our nation's employers is eroded by healthcare costs. We become angry at those companies that act to protect their competitive positions by exporting jobs to lower-cost overseas markets. But we tolerate enormous inefficiency in our health care financing system. We let our fear of governmental ineptness, keep us from passing a national health insurance plan that could be administered for a fraction of what employers pay and insurance companies charge to administer private health plans. We allow our fear of governmental involvement in our health plan to keep us in a position where we expect our nation's employers, to run their businesses and run a large portion of our nation's health plan. Our health care financing system is complex enough; we would benefit by making its management a full-time job. We allow costs to rise, unchallenged. We repeat the mantra that we must not "burden" healthcare with more regulation, though we wince as  family or friends are unable to find health insurance at any price because of a pre-existing condition.

Until we can acknowledge that the king has no clothes, we will act as if he does. Until we can acknowledge that the system is broken and the healthcare financing arrangements which have developed haphazardly will never cover all Americans, the uninsured will be with us. And along with the uninsured, we will also have higher costs for all health services and the added risk of disease and death that comes from leaving 16 percent of our population without a means to fund health care. We will have the slow job-growth and anemic wage-growth that result from employers devoting growing portions of revenue and management attention to their increasingly expensive health plans instead of toward growing their businesses. We will see the competitive position of our nation's employers weakened as they battle international competitors in countries where governments provide health insurance, and employers focus on  running thriving businesses.

Health reform proposals under consideration are not perfect. But these proposals address most of the important problems that face us as individuals and as a nation. We will be healthier and wealthier if these reforms are enacted.