We are in for a long year of Republican presidential candidates bashing health reform (even from Mitt Romney, the guy who built the model for the Affordable Care Act) and hashing out the legal case for and against the individual mandate.
Unfortunately, the more time we debate questions of coverage the less time we spend talking about the major issues of our age: cost and quality. If we could control health care costs then we wouldn’t have much of a federal budget problem or a state budget problem. And if we could puzzle out the best ways to improve outcomes then we wouldn’t have the disjointed care and medical mistakes that hurt so many people.
There are many, many ways to provide universal health coverage. Nearly every developed country extends health benefits to the entire population and no two countries operate identical systems. The United States has opted for a market based system that not only preserves, but promotes, private insurance. The Affordable Care Act basically keeps our current structure in place while expanding Medicaid and providing some subsidies so that more families can afford private plans.
But now some people want to drag us back to the beginning. For people who like tired sports analogies it’s like we are in the second quarter for a championship basketball game and our team is still sitting at home discussing what mode of transportation to take to the game. We’ve figured out transportation, just pick one. What we haven’t figured out is a science for winning basketball games. You just have to jump in with a plan and see how the game progresses and make adjustments on the fly. That’s where we are with costs and quality. There isn’t a real science yet but there are some promising ideas. We just need to start experimenting, which is what we do with the Affordable Care Act.
What some opponents of reform want us to do is allow the proliferation of high-deductible health plans and hope that expands coverage and controls costs. That ignores that most of our health spending goes to people with multiple chronic conditions and for end-of-life care. It is also a radical departure from any of the proven methods of expanding coverage that we see around the world.
I know it’s too much to ask from bitter partisans but we should just move ahead with coverage and get that out of the way. Then we could have the real conversation that will shape how health care is delivered.