Published in the Indy Start on June 21st, 2009.
By Stephen J. Jay
Since the American Association of Labor Legislation called for national health insurance in 1915, there have been at least three similar calls for fundamental change in our health system -- in the 1940s, 1970s and 1990s. All failed, despite widespread public support for national health insurance.
The collective public and private responses over the past several decades to the serious problems with cost, access and quality of health care have consisted of incremental, piecemeal reforms. These have resulted in today's dysfunctional health-care system that is not competitive, on either cost or outcomes of care, with most other developed countries in the world. Our system spends little on prevention of disease, focusing instead on "sick care."
In 2009, most experts on all sides of the political spectrum agree that our current course is unsustainable. Record numbers of Americans are uninsured or underinsured -- one in three under age 65 were uninsured for some or all of 2007-08; more than 60 percent of personal bankruptcies in 2007 were medical in origin. Over the past 40 years, the cost of health care has increased from 5 percent of gross domestic product to a projected 18 percent this year.
Disparities in health care are increasing, suggesting to some that health-care reform may be the civil rights issue of the 21st century. Dr. Martin Luther King Jr.'s words resonate today as we debate health reform: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." In a report of the Robert Wood Johnson Foundation, "Health Reform: The Cost of Failure" (May 21), the authors conclude that the cost of failing to enact health reform will be high.
In the midst of severe recession in 2009, the health status of Americans is worsening, and with a new administration in Washington the calls for fundamental health reform have intensified. The relative roles of government and private insurance companies are being debated. Proposals range from more incremental approaches to the universal health insurance "mandate model." Policymakers debate the merits of more fundamental change such as the single-payer and Medicare for all proposals.
President Barack Obama recently obtained commitment from several key stakeholders such as major organizations representing physicians, hospitals, health plans and medical suppliers to reduce the increases in health care spending by 1.5 percentage points. This would save an estimated $2 trillion in the coming decade, but there are few data that suggest this goal is achievable.
In the coming weeks the interest groups vying for a piece of the multitrillion-dollar health-care enterprise in the U.S. -- about one fifth of our economy -- will focus their arguments and intensify their rhetoric. Will the inevitable compromises strengthen or weaken the final product of reform? Will bipartisan leadership prevail or not? Will policymakers and the president place first and foremost the health and financial interests of individual Americans and their families who are currently suffering greatly?
Or will interests of major corporate entities that have thrived in our health enterprise stifle substantive reform? Will health care remain a commodity to be bought and sold by those who can afford it? Or will it become a right of all Americans?
In the almost 100 years since national health insurance was proposed in the U.S., have we arrived today at a point in time when, through public policy, all Americans will gain access to quality and affordable health care and preventive services? Only with public engagement in the dialogue on a scale not seen in decades will a positive outcome for citizens likely result.