Since I am a long way from being a health care expert, I have tried to stay away from the increasingly nasty and difficult health policy debate now raging throughout America. As a parent and as someone who is treated for a variety of typical getting older ailments, I find myself in regular contact with the health care system, but also confess to finding it well beyond my comprehension.
As a student of organizational management, I am amazed by the incompetence and waste I see, but also by the outstanding skill, dedication and improved systems that are clearly evident as well. Members of my family have found incredibly high quality treatment for heart disease at St. Francis Hospital in Long Island, and my family has also experienced wonderful care at the Hospital for Special Surgery, Mt. Sinai Hospital and Columbia Presbyterian Hospital here in Manhattan. Our personal physician is terrific, and like many fortunate Americans, my employer, Columbia University, provides excellent, though increasingly expensive, health insurance coverage.
Despite, or maybe because of the price tag, the health care system seems to be doing a good job of keeping me and my family healthy. Health care costs continue to rise in the United States, and when compared to other systems, I am told that our outcomes are no better. The issue of cost control is incredibly difficult. First, while we can educate ourselves on treatment choices when we or a family member get sick, picking a health care treatment option is more complicated than buying a sofa, car or computer. First, we are emotionally engaged in the decision due to the ultimate downside of making the wrong choice. I might be willing to make decisions based on cost effectiveness when buying a car or a computer, but when bringing a member of my family to the doctor, I want the best possible health care—regardless of price. I am not willing to settle for cost-effective health care.
Of course, it is insurance that gives me the luxury of ignoring price. Still, asymmetric information, unpredictability and emotion make it difficult for market-based cost pressure to work very well in the case of medicine. Competition does not seem to be an effective means of cost control. From where I sit, the price keeps going up, but modern medical technology is allowing many of us to live longer and healthier lives. The question for our society is then, how high are we willing to allow the price to rise? In a world of finite resources, what are we willing to give up to be able to afford all of this improved health?
There are also two other fundamental questions that must be addressed when it comes to the health care debate – the first one ethical and the second practical. The ethical question is how do we extend health care insurance to the 50 million Americans without coverage? The practical question is how do we pay for this coverage? Even in the current economic crunch, America is simply too wealthy a country to allow 50 million people—over 15% of our population—to go without health care. Logically, there are two ways to fund this: 1. Increased taxes, 2. Increased efficiency in the health care system. We probably need both, but for decades we’ve been unable to figure out how to do it. I confess that I have no idea of what might work, and would like to hear some reasoned debate on the topic.
While I am not a health policy expert, I do know something about politics, and it is the politics of health care that many of us find distressing and disgusting. The level of misinformation and anger is distressing. The sleazy manipulation of the discussion by interest groups that are simply trying to defend their dough is downright disgusting. This is a difficult and wrenching debate. We need high quality cost-benefit analysis, creative thinking and honesty. Instead, we are getting cooked numbers and shrill, uninformative lies.
Although I am satisfied with the health care I receive, I agree with President Obama that the system is not sustainable and requires reform. I strongly believe that people without health insurance must be provided with access to health care. Despite the noise and dishonesty in the media, I think there is a growing consensus about the need to restrain cost increases and about the importance of extending insurance coverage as far as possible. While it may be too late for a dignified, civil debate on the merits, perhaps we can still have one that provides real information, clear choices and improved health policy.
While the noise and anger level is unpleasant, I give President Obama credit for continuing to bring people back to the basics of the problem we must address. My read of the debate from the outside is that we don’t really know how to solve this problem. Therefore, we need to set up a reform process that changes the system, but that also permits mid-course corrections for the mistakes we are bound to make. That may be too much to ask for, but I think that is what we need.