This bill joins other landmark social legislation, like President Roosevelt’s 1935 Social Security Act, and President Johnson’s 1964 Civil Rights Act and 1965 Medicare and Medicaid Acts. And, like those previous bills, you cannot analyze their pros and cons in purely tactical terms. You have to focus on the impact of such landmark legislation on the long term evolution of the country. You have to look at the 2010 health care legislation as history in the making.
There is no question that this legislation is imperfect, perhaps considerably so. But there is also no question that health care in the US has been frozen in decades-old models that no longer work. As many have pointed out, despite expenditures that are significantly higher than those of other industrialized countries, US healthcare performance has been declining relative to these countries on just about all key indicators of health, including quality, access, efficiency and equity. Unique among industrialized countries, over 15% of the US population lacks health insurance, which according to several studies, is responsible for tens of thousands of unnecessary deaths every year.
The status quo was unacceptable. Something had to be done. Most of us would agree that, the US is better off for having passed social security in 1935, and Medicare and the civil rights act in the mid 1960s. The key question we must now ask is whether years from now, our country will be better off as a result of our having just passed these health care bills.
I believe that the 2010 health care legislation will prove to have been a highly imperfect but necessary step to help the nation evolve in the right direction. This step has been long in the making. Several attempts at health care reform were proposed and defeated in the past hundred years. Had this proposal also gone down in defeat, history shows that we would have had to wait another ten to twenty years for the next try.
Transformational change of this magnitude is very difficult, even painful for society. You are asking people to move from something familiar, however flawed and imperfect, into uncharted territory. You really don’t know what lies ahead. You are essentially asking them to trust that we will learn from our mistakes and continually improve health care over time, as we have done with other major social legislation.
In such an uncertain environment, many rise up to exploit people’s fears and oppose the changes. Some have been against the health care bills for ideological reasons. They believe that government, especially the Federal government, should not get involved in any kind of social issues. I suspect that most of those people would have been against social security, civil rights and other programs we now take for granted as well. In my opinion, their world view is out of step with today’s realities. They are fighting on the wrong side of history.
Others have opposed health care reform for political reasons. They feel that their best chance for success in future elections is to be against just about any programs advocated by the Obama administration. In their zero sum view of the world, anything that helps President Obama look good is a defeat for them, regardless of the merits of the program in question.
Many have been rightfully concerned with the costs inherent in implementing the new legislation. The rising costs of health care are clearly a major problem, especially given our growing national debt. But rising health care costs have been a serious problem for years, and constitute one of the major reasons for reforming the present system. It remains to be seen what the financial impact of reform will actually turn out to be in the years and decades ahead. Those opposed to the legislation will argue that we have jumped from the frying pan into the fire.
But, I am optimistic that we now finally have a base around which to rally together and work on fixing the major inefficiencies in the system. I am hopeful that over time, we can significantly reduce costs while improving quality. I am well aware that doing so will require much, much work in the years ahead. I truly welcome the challenge.
First of all, we must leverage all the considerable technologies, innovations and ideas at our disposal to begin to design an integrated, patient-centric health care system. Just about all experts who have examined the problem agree that unless we start looking at health care as a system, we will not be able to achieve major improvements in value for each patient, - that is, better outcomes, better quality and better services divided by the cost of providing the care. Look for example at this excellent and succinct talk given at a recent IBM conference by Dr. Denis Cortese, who just retired as President and CEO of the Mayo Clinic and is now director of Health Care Delivery and Policy at Arizona State University.
In order to have an effective health care system, we need to get to the point where everyone is insured. Universal insurance will help keep everyone as healthy as possible, as well as offer them adequate treatment when they need it. We must move away from our fee-for-service approach, which encourages lots of unnecessary and expensive treatments. We must evolve health care into a system designed to achieve the best possible outcomes for each patient for the money we spend.
We must also start moving away from our current employer sponsored insurance plans, to a plan where people are able to get health insurance for themselves and their families independent of who they presently work for. Everyone should be able to get basic insurance, which they can then add on to and supplement. Individuals and families should be free to choose from among programs offered by competing insurance companies and health care providers.The Wyden-Bennett Act is an example of such a universal health care plan, which was considered by the Senate around 2008. Although the Obama administration was sympathetic to this plan, they were worried that doing away altogether with the employer-based plans that most people have would be considered too radical a first step, and thus politically unacceptable by those families that are satisfied with their present insurance plans.
Hopefully, we can revisit such proposals once the rhetoric has cooled down in the future. An employer-based insurance system no longer makes sense, given our fast changing, dynamic markets and our fluid, mobile labor force. As this Newsweek article observes: “America has always been a mobile society, with a labor market that grows more fluid over time. Once, the norm was to work for a single employer for one's entire career. Today, people change jobs an average of 11 times before they reach 40. Fear of losing health coverage keeps people in jobs they would otherwise leave, creating a drag on economic efficiency.”
Furthermore, many people lose their jobs because of changing economic conditions. As we well know, many have lost their jobs as a result of our ongoing financial crisis. The US unemployment rate was 4.8% in February of 2008. It has more than doubled since then to 9.7%.
Given that people are going to be changing jobs multiple times throughout their professional careers, it makes no sense whatsoever to link their health insurance to their current employers, especially if they get laid off and need stability in their life while looking for their next job. The only reasonable way for us to have the kind of dynamic, open, market economy that we relish in America is for individuals and their families to have the proper societal safety nets as they transition between jobs.
You can always count on Americans to do the right thing - after they have tried everything else, - Winston Churchill is supposed to have famously said. For too long now we have tried to avoid dealing with the thorny problems of health care reform. But, at some point, we have to put aside ideology, politics and even financial considerations, and finally face up to the challenge because it’s the right thing to do for the country. We are finally on the right side of history.