Americans want the best possible health care for the greatest number of people at the most reasonable cost. I do not think we are going to get it for a long while. The ACA has been good for the country. Medical coverage has been provided to many who had no access to insurance previously. The language of “pre-existing conditions” has sensitized us to the plight of the critically ill. The coverage mandate has made contributing to health care a part of the common good. Yet, the ACA has not reduced the costs of coverage. Exchanges are failing nationwide and the stress of health care inflation is a growing burden on all levels of government and health care administration.
Yes, health care is a messy system, loosely understood, but generating a great deal of cash that is spread-out globally. We are looking to our Federal legislators to reduce the messiness and to have the money generated within the system make health care operationally and financially workable for all of us. Our legislators do not seem to be doing the job. These legislators seem to be locked into three worldviews that are exercised at the level of sacred religions. The first is the Market World View with Rand Paul as its major proponent. He is vehemently against any stabilization funding for the insurance industry. For him, the markets will dictate the proper outcomes.
The second is the Subsidized System World View held by the unified Democratic Party. Build on the Medicaid entitlements through Federal funding and make sure all citizens are covered fairly, all the time, for all conditions. These are over-simplifications and, no doubt, lacking in correctness. Nonetheless, they are treated in many ways as sacred religions without the depth of understanding of the business models driving the finances of health care policy. American policy for most industries is a combination of market forces and government intervention. Broadcasting, air transportation, global shipping, etc. each has to deal with the same balancing act facing health care. What our health care legislators fail to realize is that every worldview is restricted and in need of a negotiated order.
The third is the Keep Your Customer Satisfied World View. Legislators want to serve their constituents and be re-elected. This might be the most powerful of the three world views and the most dangerous. The patient/constituent has real skin in the health care game and needs knowledgeable, responsive leadership from legislators. Yet can legislators who are locked into a scared religion worldview truly serve its “customers”? Probably the best way to serve is to have the customers better understand options that would allow for better decision making. Rather they are presented with the sacred religion worldviews the context of emotion, not in the logic of causation that would lead to the best possible health care for the greatest number of people at the most reasonable cost. This type of education would give our legislators real skin in the game.
University of St. Thomas Center for Innovation in the Business of Health Care.