Health care has been top of the American mind for decades, as the price of medical care in the country has skyrocketed and outcomes here fell well behind other first-world countries.
Little progress has been made. Entrenched interests — politics, Big Pharma, insurance companies, lawyers, the American Medical Association, government bureaucracy, etc., etc. — has helped keep costs on a constant rise. And the gap between us and other rich countries has only grown wider when it comes to life expectancy, infant mortality rates, access to care and more.
We must say, of course, that the American health care system can be the best in the world, if you can afford the best. But if we want more Americans to live longer, healthier, better lives, then how do we make the health care system work better for more Americans?
If you can answer that question, please run for president.
For all of us who don’t have the answer, let’s first take a brief view of the lay of the land. The Affordable Care Act (aka Obamacare) took a shot at improving the system when it was passed in 2008. It consisted of hundreds of pages of rules and programs and acronyms and pilot projects, but at its heart was a simple concept: the rich and healthy would pay more to allow the poor and sick to have health insurance. That’s fine and good, and some would argue a noble effort that does the most good without unfairly punishing those who can’t afford it. Others would argue it is an unfair system — government sticking its messy hands into the free market, personal decision-making and the plain old luck that affects the trajectory of life in the land of the free.
Either way you see it, the ACA did not tackle the cost of care in America. And even though more Americans have health insurance, many cannot afford the subsidized premiums nor pay their share of the health care they receive, even when using their government-mandated insurance. In those arenas, the ACA has not helped consumers. It has, however, helped the millions of sick Americans with pre-existing conditions get coverage, which increased the cost in the system more than many projected, including the insurance companies.
Republicans have loudly railed against the law over the last decade, and their win last November gave them the White House and the ability to make their mark on American health care. So far, they’ve had a troubling health care bill pass the House, a similar bill hit a sticking point in the Senate, and have not found enough votes to even muster a straight-forward repeal of Obamacare, which would put much of the pre-2008 rules back in place.
We’re not at the precipice of an apocalypse, however, and the hyperbole from both political parties moves us farther away, not closer to a solution.
Some Republicans called Obamacare the “worst law in our history,” which is patently absurd. The ACA was a rather conservative approach to making a big change in the way many Americans access care. But on the other hand, Democrats are accusing Republicans of sending millions of Americans to an early grave by proposing their own changes, which return tax cuts to the rich and attempt to give poor and middle-class Americans tax-free alternatives to paying for their coverage and care.
There is broad support for upgrading and improving health care in America, despite the pessimism and death threats from our political parties.
Even many Republicans have come around to the idea of “Medicare for all,” a more palatable way to describe a more socialized medical system. Many Democrats are OK with wholesale changes to the Affordable Care Act, and realize that may include scrapping Obama’s signature achievement in order to enact something better.
How to do that is terribly complex, and risky. Many politicians have tried and failed to do something about it, and others tiptoe around and wait for others to take on the heavy lift.
It’s even more delicate in rural America, where many doctors and hospitals and clinics are surviving on razor thin margins, and depend heavily on government programs like Medicaid.
American health care is a mangled mess of entrenched interests, and at the heart of it the complicated science that is modern medicine. Keeping people healthy and alive is something that cannot be done in a vacuum, and the country’s health care structure must somehow be both strong and flexible.
Voters and politicians must own up to the fact that this country is spending much too much money on it — nearly 20 percent of our entire economy — and we’re not getting acceptable results. Give the ACA credit where it’s due, but own up to the fact that there are significant problems with it that need fixing, right now.
Americans are a wonderful, weird group of humans. We’re risk takers, we drink too much and eat way too much, and we drive our cars too far and too fast and we have too many guns around and we don’t sleep enough and we ingest tobacco and red meat too darn often. All of those things make us less healthy, but more free.
We’re also varied demographically and culturally and we live dramatically different lives in urban Chicago or rural Montana, as a multi-billionaire in Manhattan or homeless on the streets of San Francisco. This makes a national health care system even more complicated than a country like Sweden or Denmark, which have the best health care systems and quality of life.
It will take all hands on deck to improve health outcomes: A more efficient, smarter government system. Better choices from Americans, from our diets to showing up to our annual checkups. Doctors who keep cost in mind. From Washington, D.C, we should demand debate that rises above partisanship and frames health care as the critically important, immensely complex issue it is.