Leave it to Michael Moore to capture the complicated. In a New York Times commentary last week, Moore assailed the inadequacies of President Obama’s health care reform legislation, but celebrated the opportunity its advent creates for states to take American health care where, in his judgment, it needs to go.
Every nation at some point decides there is value in providing access to quality health services to all its citizens. From Bismarck’s Germany in 1880 on, each has chosen its own course. In each case, the government has become the biggest player in financing everything needed, because markets do not respond well to people in need who lack both financial means and the ability to make informed decisions in both their best interests and those of the community.
The choice in every country but ours has been some variation on a single-payer, universal system. Liberals like Moore will always favor that choice.
What’s interesting about the United States is that we’ve chosen not to have a national system, instead allowing local cultures and values to shape our health, our medical advances and the role of government in providing access.
There have always been health professionals who have tried to shape their practices and government’s role in ways that improve quality, access and affordability. But the predominant American medical culture — and therefore our expectations — assumes that we are each entitled to the best our country can produce, that government needs to keep financing invention and discovery, that discoverers and inventors and the professionals who apply their products need to be richly rewarded, and that government will have to pick up an increasing share of the costs.
Since the early 1970s, our elected leaders have debated how best to expand access by bending an ever-escalating cost curve. By 2007-09 it had become clear to them, and to health care providers and insurers, that it was time to act on what most believed was the best policy course in between the liberal’s single-payer policy and the status quo conservative’s preference for high-deductible catastrophic insurance purchased over state lines and funded by tax subsidized health savings accounts.
The result of the difference splitting is the Affordable Care Act, a k a Obamacare.
There is never an ideal time for government to change an entire national approach to satisfying citizens’ needs regarding something as complicated as health (food, diet, exercise) or health care (illness, accident, disability, aging). Similar complexities confront us in education, housing or national-security reform. But with our national economy collapsing, as it was in 2007-09, and our individual family economies held hostage to health insurance premiums (as they continue to be), the nation’s leaders could no longer afford to wait. Nor to debate “my-way-or-the-highway” policy showdowns.
For that reason, this president, the majority in Congress and most leaders of the health care industry put us on the course that resulted in the ACA.
The law, and what its implementation would involve, was well-understood by the industry — even by those who refused to acknowledge that this change was good for them. It was not understood at all by Americans. This change, with all its complications and implications for every person and family, has never been explained to us by its proponents in government or in the industry. So the piecemeal “rollout” is easily criticized and the attractiveness of a “single-payer” European model is enhanced.
Moore suggests that we use our 50-state federal system of governance to let the people decide which health system they would prefer. As he points out, the industry will object, starting in Vermont, which has chosen single-payer.
However, it’s just possible that out of this new version of an age-old debate will come the dream of a genuinely bipartisan national effort to reform Obamacare, thus educating us all — starting with the many elected officials who refuse to get involved in the complications of any issue for fear their supporters will turn on them.
Dave Durenberger is a former Republican U.S. senator from Minnesota and chair of the National Institute of Health Policy.