During the past four decades our health policies have failed to meet national needs because they have been heavily influenced by the delusion that medical care is essentially a business. This delusion stubbornly persists, and current proposals for a more "consumer-driven" health system are likely to make our predicament even worse. I wish to examine these proposals and to explain why I think they are fundamentally flawed. A different kind of approach could solve our problems, but it would mean a major reform of the entire system, not only the way it is financed and insured, but also how physicians are organized in practice and how they are paid. Since such a reform would threaten the financial interests of investors, insurers, and many vendors and providers of health services, the short-term political prospects for such reform are not very good. But I am convinced that a complete overhaul is inevitable, because in the long run nothing else is likely to work.At the time Mr Relman didn't think it was going to happen any time soon because those with a vested interest in keeping the current system owned to many politicians. Well less than two years later Ezra Klein thinks that enough people and organizations now realize how broken the US health care system is and think it might be time to be
THE STATISTICS, by now, are well known. Forty-seven million uninsured Americans. Premium increases of 81% since 2000. Small businesses failing, big businesses foundering, individuals priced out and, amid all this, skyrocketing profits for insurers, hospitals and pharmaceutical manufacturers.So what changed in two years? It's simple, there are more powerful people losing money under the current system than are making money. I never for one moment thought that health care in the US would change because it was the right thing to do but that it would come when it became an economic necessity. Businesses large and small can't compete on the national stage because of the burden of our inefficient health system. Even the insurance companies are beginning to have difficulty showing a profit are more and more individuals and businesses are priced out of the game.
The American health system, put simply, is a mess. An expensive one. Indeed, in 2002, we spent $5,267 per capita on healthcare — $1,821 more than Switzerland, the nearest runner-up. And yet we had higher infant mortality, lower life expectancy, more price inflation and an actual uninsured population, a phenomenon virtually unknown in the rest of the developed world, where universal healthcare is, well, universal.
These are unsustainable trends. The U.S. healthcare system cannot, in its current form, go on forever, or even for very much longer — employers can't afford it, individuals can't handle it and the country's conscience won't countenance it.
And change may come sooner than most think. Across the country there are unmistakable signs that the gridlock and confusion sustaining our sadly outdated system are coming to an end and that real reform may finally emerge, possibly even starting in California, where Gov. Arnold Schwarzenegger is promising to spend his upcoming State of the State speech explaining how he will push the Golden State closer to universal healthcare in the coming year.
Klein explains that changes are on the way on several fronts.
But there is evidence, finally, that their castle is being stormed. Massachusetts has passed the nation's first near-universal healthcare plan, creating a structure that should cover 95%-plus of its citizens by making healthcare as mandatory as car insurance. Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.So change is coming and we must convince the legislators to ignore the special interests of the Medical Industrial Complex and come up with a good plan the first time.
Surrounded by an unlikely array of union leaders and corporate chief executives, Sen. Ron Wyden (D-Ore.) has unveiled an inventive, comprehensive reform plan that would end the employer system forever. What businesses pay in employee premiums would be redirected to employee raises; insurers would offer their plans through state associations that would no longer allow price discrimination for reasons of health or job status; and everyone would have to buy in. Universal coverage would be achieved in under two years.
The most compelling evidence that resistance to reform is futile, however, is coming from the insurers themselves. Cognizant that Congress and the nation are tiring of the current dystopia, the insurance industry recently released its own plan for universal healthcare.
It's a bad plan, to be sure. Its purpose is more to preserve the insurance industry's profits than improve healthcare in this country. But the endorsement of universality as a moral imperative, and the attempt to get in front of the coming efforts at reform, mark the emergence of a distinct rear-guard mentality within the insurance industry. Their game is up, and they're turning some of their attention to shaping their future rather than betting that they can continue protecting their present.
More on Senator Ron Wyden's plan above.