I happened to see Face The Nation yesterday. Governors John Kasich and John Hickenlooper were on, talking about their attempted bipartisan solution to health care reform. Their basic idea is that they and their staffers should be able to compromise and come up with a better proposal and possibly model cooperation for all of the uncompromising members of Congress. Things did not look very well after the opening question by host John Dickerson:
"And we have seen in Washington both sides say they don't want to give up much of anything. Give me your sense of what Republicans should back down on and what Democrats should back down on just as a preliminary good-faith effort to show that people are, on the health care question, committed to maybe working together."
I took out the key statement for both responses and included them in the above graphic.
The statements are very telling in terms of political rhetoric disguised as political philosophy. Kasich seems to believe that there is a free market at work. Hickenlooper seems to be more focused on the insurance principle of adverse selection - in this case the buyers of insurance with health problems are more likely to buy health insurance than younger healthy people without health concerns. That leads to a concentration of buyers who increase the risk for the insurance company paying out and in the worst case a loss for the company. Translation - the Democrats should give up on the idea of mandatory health insurance and the Republicans should give up on the idea of repealing mandatory health insurance. That is quite a compromise.
An ethical framework is probably a better one to start from. As I argued in a recent post - if your ethical priority from a political perspective is to allow people to have a choice - then give them choices when it comes to health care. No choice is not an ethical option. If your ethical priority is the value of human life - then universal access is necessary. If the ethical priority is making sure that the resources being used by people who need health care services is finite and needs stewardship - then by all means make the entire system more cost effective for society at a whole.
All of the suggested ethical approaches cannot occur when the level of financial conflict of interest is large like it is in Congress. Members of the US Senate get on the average $438,000 in donations from the Health care sector (PACs and individual contributions in the 2015-2016 election cycle). That is a powerful incentive to keep making arguments about free markets and insurance markets that do not make any sense. They make even less sense when it is clear that these same politicians are being lobbied to maintain the status quo - even though it is the most expensive and most inefficient health care system in the world. The following graphic on the accumulation of administrators relative to the increase in physicians is just one illustration of that point.
Personal Communication David Himmelstein with his permission - July 2017.
So the next time you hear about the need for compromise and results from Congress, keep this scenario from Face The Nation in mind. Unless you have a reasonable assessment of what the problems really are, there is no starting point for compromise or consensus building. Policy makers in Washington are so far removed from an accurate assessment of the problem bad policy after bad policy is the logical outcome.
In discussing the problem with them a fair question is why the United States is incapable of coming up with effective health care at a reasonable price when all health care is currently rationed by for-profit companies.
It does not take single payer to get a better result, but it does take a government that is for the people rather than big health care business.
George Dawson, MD, DFAPA
1: Face The Nation Transcript from August 6, 2017: Guests included Tom Cotton, John Kasich, John Hickenlooper, Jeh Johnson, Susan Page, Reihan Salam, Jennifer Jacobs and Jamelle Bouie. (Accessed on August 6, 2017).