At the moment of this writing, the Congress and president of the United States are scrambling to come up with legislation to shape how health care will work in this country for the foreseeable future. This issue has been a growing economic and ethical problem and a political football for decades. Neither the Affordable Care Act (Obamacare) nor anything now being proposed can provide a broadly accepted system universal health care.
In little more than two centuries, this country has accomplished more astonishing things than any other in human history. We seized and settled much of a continent full of resources and possibilities. We slaughtered one another and devastated vast areas in an uncivil war but emerged as one country and by the end of that century became the dominant force in the Americas. We overcame the Great Depression and then fought and won a global war on two fronts. Both the Atlantic and the Pacific became "our" ponds. Then came the space race and space became "ours," too. Out of that came the miniaturization of computers and other electronics, resulting in social and economic revolutions beyond the imagination of people 50 years ago.
Today the United States is the economic and military colossus of the world. However, it does not seem to have the genius and leadership to work out a health care delivery system for its people. There has been no shortage of brilliance in the sciences and technology to understand the human body and its illnesses or to discover effective treatments and preventions. But something is lacking when it comes to managing costs and fitting people to needed medical services.
Be clear. Making health care available to everyone is not impossible. Canada and most of the countries of Western Europe have systems that work. They are not perfect, but they provide the basics to everyone. Sometimes people have to schedule doctors' visits well in advance except in case of emergencies. (Funny, but I have noticed the same thing here in recent years.) There often is a two-path pattern — one for ordinary folks and another for people who are rich enough to pay for private care. Still, health care is available to everyone and no country has gone bankrupt because of it.
Efforts to solve the health care problem in the United States have largely focused on distribution — ways to put people and needed services together. The problem is that costs are high and climbing, making it hard to finance the distribution of services.
Litigation or the fear thereof drives up costs. Every doctor, every hospital and all of their staff must be covered by malpractice insurance. Yes, mistakes are made and there should be appropriate compensation. But there are fraudulent claims by patients and enough ambulance-chasing lawyers to press their claims. Fearing the cost of litigation and possible negative publicity, some providers and insurers do not put up much fight even when they suspect fraud.
Even when cases go to court, there is the problem of generous jurors who think, "Well, insurance companies have got plenty of money."
Wrong! They do not have printing presses. They have money from premiums and investments. If they pay out a lot of money on claims, they have to increase premiums — more costs to doctors and hospitals — thus to the health care system. Exorbitant judgments should be subject to automatic review by a panel of judges and physicians with the power to adjust the judgments to an amount they deem reasonable.
Cost management must begin at the top with the individuals and corporate entities that most impact health care in this country. It happens in other places, but I am not sure there is the necessary political will to make it happen here.
Since I am an advocate for old folks, it disturbs me that the latest proposal allows people beginning at age 50 to be charged five times as much for health insurance as younger people. Obamacare was bad enough with a three to one ratio. It is true that seniors have more health problems than younger people, but the evidence of actual cost does not support anything like that disparity. And if they have to depend on Medicaid, they are in a world of hurting, literally.
Roger G. Branch Sr. is professor emeritus of sociology at Georgia Southern University and is a retired pastor.