It took a hundred years, but now we have national health insurance. The policy first proposed to the nation by Theodore Roosevelt in his 1912 third-party presidential campaign is now, in 2012, the law of the land–certified by the Supreme Court. And yet as we look ahead to the next century, we might ask ourselves: Is there something more important than health insurance? Like, say, health itself?
Barack Obama could well lose the 2012 presidential election, and if he does, the Affordable Care Act will be one big reason. Not only is the personal mandate–now judged to be a tax–intensely unpopular, but the whole national healthcare effort has been judged to be a diversion away from fixing the nation’s economy.
Yet polls also show that overwhelming majorities of Americans support key features of the legislation, such as the requirement that insurance companies cover people with pre-existing conditions and insure young people up to age 26, as well as Medicare’s filling of the “donut hole” for prescription drugs.
So even if the much-derided “Obamacare” were repealed, certain commitments within the legislation are likely to be kept, perhaps under a different name. The private health insurers will argue, for example, that they need some sort of subsidy if they are expected to provide even the “uninsurable” with insurance. Faced with the threatened collapse of the private health-insurance market, leaders in both parties will find some new revenue source to pay for the insurance.
Indeed, we’ve had a primitive form of national health insurance since 1986, when President Reagan signed the Emergency Medical Treatment and Labor Act, which guaranteed everyone access to most hospital emergency rooms, regardless of ability to pay. It’s hard to find a Republican who talks about repealing that legislation. Yet to keep hospitals from going bankrupt, Congress set up the Disproportionate Share Hospital program, which provides more than $11 billion a year to support hospital emergency rooms.
Inl reality, no matter which party controls the White House or Congress, anyone who is “on the grid”–that is, visible to the public–is going to get at least some treatment. Not just because we are compassionate, not just because activists with bullhorns can get on TV, but also because we are practical; in a dense-packed society, we want to see minimum standards of public health. Even the most selfish of us don’t want people in our midst walking around with TB, whooping cough, or bugs from any number of possible new epidemics.
So what to do? Are we doomed, then, to a costly system that produces lousy outcomes? Liberal critics of the status quo have a point: We have the most expensive healthcare system in the world, and yet healthcare outcomes put us in the middling ranks of the industrialized countries. We might note immediately that a big part of the reason why we don’t have the healthcare outcomes of, say, Japan or Finland is that we don’t have the population of Japan or Finland. And so, in keeping with the federal government’s track record in recent decades, it’s unlikely that Obamacare is going to work as advertised, lowering costs and improving outcomes.
We might also note that affluent people like healthcare–they want more of it, not less. Medical treatment is what economists call a “superior good.” That is, the higher one’s income, the more one wants to consume; according to a 2009 survey from the Kaiser Family Foundation, 67 percent of Americans think that they are not getting enough medical treatment, while only 16 percent think that they are getting too much. Moreover, there’s plenty of evidence that those thrifty/healthy countries that American liberals so admire are starting to spend more on healthcare, too. Indeed, they are quite possibly spending their incremental healthcare dollars seeking treatment here in the US.
So back to the question: What is to be done? We might start by reflecting that the past century’s worth of debate has been preoccupied by healthcare finance–that is, who pays? During that same century, we have scored major healthcare successes outside of the health-insurance realm, notably the elimination of polio in the 50s and the near-elimination of AIDS as a killer in the 90s. We might note that such breakthroughs make healthcare cheaper, because, after all, healthy people not only don’t cost much but also are themselves economically productive. Yet profound breakthroughs against disease have been relatively scarce in recent decades, in large part because the political class has been arguing, instead, about finance.
In fact, the number of new drugs, medical devices, and antibiotics has plummeted over the last two decades, as has the available amount of medical venture capital. In the current environment of predatory trial lawyers, a Naderite FDA, de facto price controls, and zero leadership from the finance-focused political class, it’s little wonder that medical researchers and entrepreneurs have migrated into other sectors. It’s a lot easier to make money creating a new social network than it is creating a new wonder drug.
So here’s an estimable, life-saving, healthcare project for the next hundred years: Let’s shift over to the truly cost-curve-bending track of medical advancement. After all, a cure is cheaper than care. And if, as has projected, we’re looking at a cumulative cost of Alzheimer’s treatment reaching $20 trillion by the middle of this century, we should realize that no envisioned healthcare-finance scheme–public or private, anything less than “death panels”–is going to do much to reduce the inherent cost of 24/7 dementia care for tens of millions of Americans.
For the sake of our health, as well as our fisc, we need to focus on curing disease, as opposed to financing it. That means peeling back the predations of the trial lawyers and streamlining the FDA for starters, but it also means “moon shot” political leadership that mobilizes resources, public and private. It doesn’t have to be bureaucrats, whom nobody trusts anymore; it could be some new hybrid organization. Why not an “X-Prize” for curing Alzheimer’s, or for helping wounded warriors–and other victims of paralysis–walk again?
This is still a rich country; our annual GDP is $15 trillion. And it’s a rich world, too, boasting a total GDP of some $60 trillion. So there’s plenty of money to solve big problems, if we genuinely want to solve them. Yet we can start that process only if we traverse from a preoccupation with finance, fiddling with numbers–to a new focus on science, saving lives and saving money.
James P. Pinkerton is a contributor to the Fox News Channel and a TAC contributing editor. Follow him on Twitter.