Some years ago, an anthropologist studying an American Indian community and the neighboring non-Indians noticed that each community tended to define the other, and by implication themselves, as what they were not. He called these “nondescriptions” and pointed out how they hindered real understanding.
It seems to me that something like this is going on regarding healthcare. People and politicians alike freely talk about what’s wrong and what they don’t like, but seem unable to state with simple clarity what they want and how they intend to get it.
It’s just not enough to say “repeal Obamacare.” We have a major crisis brewing in health care — what do you want?
First, do we have a major crisis? Here’s what I learned in my research. In the U.S. in 2014 we spent $3 trillion on health care, about $9,500 per person. This includes everything from Medicare to Veterans Affairs, from drugs to dental. The U.S. population is about 320 million, incidentally, so that means that health care costs about $800 per person per month. Wow!
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Perhaps the best way to think about this cost is as a percentage of the Gross Domestic Product. GDP is the wealth generated by the nation’s economy. In 1990 health care was 8.9 percent of GDP. This percentage has grown each year and in 2014 it was about 17.8 percent.
Here’s another statistic comparing 1990 with 2014. Of the total population, the under-age-18 section has steadily decreased. Also decreasing is the age 18-64 section (the main age of economic productivity). However, the 65-plus age section is increasing.
It doesn’t take a genius to see that our current health care system is not sustainable. The health care challenge is not what to do with Obamacare, but rather what major changes are needed to make the system less costly, and therefore viable for the long term.
It’s not like this nation cannot successfully address substantial and complex problems and challenges. We manage to get children educated (even though there are arguments about the details) and we have a highway system that connects every community in our nation (although there are needed improvements). And, we deliver electricity to every house at an affordable cost.
Recently, President Donald Trump said about health care reform, “It’s an unbelievably complex subject.” It sure is, especially if we cannot even agree on the basics. For example, do we agree that, as an extremely wealthy nation, we want to provide basic health care to all our citizens? Or is health care more like a luxury good, available only to those with personal wealth or who are willing to go into debt to get it.
Personally, I think that health care would be best managed with a utility model, as something that needs to be provided to all at an affordable price. Some utilities are public, some private; all are regulated and have cost control built into that regulation.
Of course, I should not pretend to have any real expertise in health care and its delivery. I’m a consumer, just like most of you. But I know a few things.
I know that the economy of scale is real. The bigger the system is, the less it costs to deliver the product. In nations with national health systems, health care costs are much lower, primarily because of economies in the management end of the system.
I know that many doctors end up with huge debt when finishing school. Why cannot we provide no-cost medical and dental school tuition to qualified applicants? We desperately need doctors and they have a calling to serve; they should not be burdened with debt worries.
I know that health care providers employ multiple people just to manage the many and varied insurance forms required by multiple companies. It would be an immediate cost savings to have a uniform reporting system.
And, most important, I know what I want for every U.S. citizen. I want us to be free of worry concerning health care, to be issued a card and feel safe knowing it’s all one needs. No insurance variables, no preapprovals, no co-pays. And, I’m willing to pay for it.
How about you? What do you want?
George Walter is the Nisqually Indian Tribe’s environmental program manager, and is a member of The Olympian’s 2017 Board of Contributors. He may be reached at firstname.lastname@example.org