New Deal For Healthcare

While Americans rejected the Clinton health care reform plan a decade ago, they might be more amenable today to a Rooseveltian New Deal for the health care that they see slipping away from them. Like the 1930s social reforms, the solutions proposed in this book are radical and far-reaching. But they could provide universal coverage and reduce health costs by 30 percent or more if we can just make a few adjustments in our thinking about health care.

To start, we need to drop our resistance to government intervention. Although local control of most elements of health care is preferable to central direction, only the federal government, working with the states, has the power and the authority to implement the changes that need to be made. Moreover, as I point out in the final chapter, restraining future cost growth will require a national organization to assess the value of new technologies.

Some observers will attack this approach as a form of socialism that places intolerable constraints on health care entrepreneurs. But this route to universal, comprehensive, affordable coverage would preserve much of the free-enterprise system. It would add just enough government intervention to make the system work properly. And while it would produce wrenching changes in the short run, it would put us on the path toward better health care at a price we can afford.

We also have to stop thinking in terms of choosing among insurance companies when we buy coverage. Since most plans include the majority of local health care providers, the competition should be among provider groups instead. That, of course, would require more physicians to join groups, and it would relegate insurance carriers to a secondary role. Many insurance jobs would be lost, and doctors would have to take financial responsibility for their own services. But these reforms would restore control over health care to doctors and patients, where it belongs, and it would give every patient a free choice of physicians.

For this solution to succeed, we would have to stop believing that more care is always better or that every insured person is entitled to everything that health care providers can possibly deliver. This goal would be the trickiest to achieve, given the entitlement mentality of the public and the ceaseless drumbeat of publicity about the latest medi¬cal advances.

Here, physicians would have to lead the way. They would have to learn how to manage care and how to explain to patients why they cannot have everything they want. No doubt, many people will object; but since we don’t have unlimited resources, there must be a budget, whatever kind of health care system we have.

“Our system is going to continue in a death spiral until we come to the grips with the fact that we can only afford so much,” says Jonathan Weiner, a professor of health policy at the Johns Hopkins Bloomberg School of Public Health. “We need a fixed budget like every other system in the world. And then we need to figure out how to meet our needs within that budget, or collectively we have to add to the budget. Morally, we’re on very shaky ground until everybody gets at least basic health care. Giving some people wasteful health care and others, none, is completely untenable. If we gave everyone decent health care, and others wanted to pay more to get more, that would be fine.”