Welcome to “Fixing U.S. Healthcare – A Doctor’s Blog.” Over the five years between October 2017 and December 2022, this blog analyzed healthcare reform, challenged assumptions, and explored fixes from various angles.
In December 2022 this blog concluded that although the U.S. had not reached the goal of universally accessible, costworthy healthcare, this blog had by then grown more confident that a sufficient constituency now framed the project fully informed by eclectic viewpoints and showed willingness to address it in its full complexity.
The author has signed off this blog, but the reader is welcome to review previous posts, including its final summary.
Background
U.S. healthcare has been a key issue in every election since 2016, when candidate Donald Trump promised to fix it.
Each subsequent candidate has framed the problem differently, some emphasizing universal access and others asserting need for “market competition.” Once elected, they have all faced the same obstacles to U.S. healthcare reform as confronted other Presidents these last 40 years — how to control costs and maintain quality while ensuring access for all. And how to overcome vested interests and lack of political consensus.
The Symptoms – Unsustainable Costs & Early Deaths
Leaders have come to recognize that relentless cost increases are built into the system, but hidden from public view until recently. In the campaign, President Biden and his fellow 2020 candidates all named those rising healthcare costs as a top campaign focus.
These now-not-so-silently rising costs are simply unsustainable. They negatively affect the U.S. economy, politics and society. In addition, many Americans are beginning to question whether they are getting their money’s worth from so much healthcare spending. Most importantly, healthcare costs are now hitting Americans directly in the pocketbook. All of their gains in wages during the first decade of the 2000s was offset by increased premiums and copays, keeping their take-home pay flat. Healthcare costs are now a top cause of household debt and often of bankruptcy.
Moreover, a new study in July 2022 now reveals a “crisis of early deaths.” Although the U.S. pays twice as much for healthcare as most other advanced countries, its citizens have higher mortality rates and die younger than in those countries. This finding is especially stark when comparing years of productive life lost among countries. “Missing Americans” are dying in the prime of their lives, dragging down the economy, contributing to inflation, and tragically resulting in “empty seats at the table.”
This blog has welcomed this focus on healthcare cost issues. It originally touted a policy approach — cost-benefit analysis — pioneered in Oregon 25 years ago, which successfully restrained costs while maintaining near-universal access to costworthy, quality care. This blog has now claimed that an even more aggressive approach is needed at a national level to solve today’s healthcare challenges.
It has taken on more urgency in the face of the tragedy of early deaths and missing Americans.
In the face of the coronavirus pandemic, this blog further concluded that health, healthcare access, and the healthcare system are best understood as a public good, part of the social contract to which we all contribute in order to derive a greater collective benefit. So, in today’s complex society, good government must play an indispensable role in healthcare. Government should promote market mechanisms when advantageous and appropriate. And government must be accountable to we-the-people and must be managed by skilled public administrators. Fixing healthcare is too important to be left just to private corporations (especially health system monopolies) and to other powerful special interests.
The Root Cause – Power, Greed and Smokescreens
However, “routine” common-sense healthcare reform has been blocked, in the view of this blog. The root cause is greed of the few over against the wellbeing of the many. These greedy few leverage their power to protect their own advantage. And, in service of their power, they propagate distorted messaging that obfuscates public understanding and divides the public will for a better healthcare system.
This blog endeavored to ferret out these root causes. It has advocated not just for healthcare reform but also for the social, civic, and political reforms that must precede it.
Fixing U.S. Healthcare 