Watching the US healthcare debate, from Clinton to Bush to Obama makes me weep. Second only to environment, in my opinion, health care has been a pawn in the right/left political debate, where both sides have allowed short term political positioning to trump advances on an issue critical to our lives. And it is, literally, killing us.
First a couple of facts
- the US spends more per capita on health care than any other country in the world, by a lot. At 8,500 per person he US spends 50% more than the second highest speeder (Norway)and almost twice as much as my home country Canada.
- for this enormous investment, the US isn’t getting a great return. The Word Health Organization ranked the US healthcare system 37th in terms of efficiency. That’s efficiency – value for dollar. In terms of outcomes, the Institute for Health Metrics and Evaluation found that in nearly every major cause of premature death – from heart disease to interpersonal violence – the US does worse than its economic peers.
So, clearly there’s room for improvement.
I believe there are some core principles we can all agree on (some of these are a little controversial, but I believe they make sense if you think about them).
- every American should have the right to basic healthcare, no matter their socio-economic situation;
- given the level of US prosperity, this “basic’ healthcare should be pretty good and it should include treatment of pre-existing conditions and it should include end-of-life care;
- given the aging US population and the high cost of healthcare (17% of GDP), costs must be controlled
- health service providers (doctors, nurses, etc) must be provided with reasonable compensation
- The perfect cannot be the enemy of the good. The status quo is both horrible and unaffordable. Yet every reform package (think Obamacare) is torn apart because it is sub-optimal in comparison to some idealized gold standard; we must except that not every healthcare issue or individual citizen will be ideally treated by any health care system and the media and political tendency to exploit every failure is simply a recipe for the status quo.
- finally, politicians cannot design the details: heath care reform is simply to complicated and too easy to manipulate for political short-termism. Politicians should articulate the principles and a bi-partisan, blue ribbon panel of experts should design the details. Government should then implement whatever they come up with.
You may notice I took a different tact in this Common Grounds Blog. I didn’t highlight where the religious right and progressive left disagree. This is because I honestly don’ think they really disagree on anything that is important. This is why Romneys’s healthcare plan became Obama’s. What has happened is this: the right and left wing politicians have convinced their constituencies that they disagree because it is an amazing wedge political issue. What do they disagree on: whatever the the other side proposed.