Fixing U.S. Healthcare: Signing Off

2022.12.28 Lookout--Menhaden_Fishing

Fixing U.S. Healthcare blog has accomplished its mission.

Yes, mission accomplished – but not single-handedly, of course. In the blogosphere and in the public square surrounding this blog, the healthcare reform debate has matured from a simplistic, sometimes-childish sandbox fight now into a reflective, evidence- and values-driven, sophisticated discourse, worthy of a vibrant democracy.

The new discussion points the way toward healthcare reform.

That was the goal – to analyze, to challenge assumptions, to explore from all angles. And, thus, to allow the healthcare reform debate to frame itself for us, not for us to squeeze it into the mold of our own biases, preconceptions, and mindsets.

In fact, this insight – that healthcare reform unfolds organically as a never-ending process, not as a march toward a final fixed state, and that it will need to draw on every possible perspective from every quarter – seems to be taking hold in the U.S. and elsewhere.  Not everywhere just yet, but enough places to give hope that there will be no going back.

And so, after five years, 123 posts, 3,399 views by 1,943 readers (some repeats) in over 45 countries, this post number 124 will be the last. (We will leave all posts up online for the time being.)

Let’s look back and summarize where we started, where we’ve come, and where we’re headed.

Where We Started

In 2017 Donald Trump had just taken office as President. He vowed to “repeal and replace” Obamacare with “something better.” Millions loved the sales pitch. And many leaders, each with their own agenda, thought they could leverage the wedge healthcare issue to unleash a healthy dose of deregulation, competition, and limited government, in hopes that market forces would do the rest.

This blog was skeptical of leave-it-to-the-market. Nine months later, President Trump himself mused, “Nobody knew healthcare could be so complicated.”

This blog, itself, proposed an equally simple fix:  Cost-benefit analysis, followed by prioritization of high-value services within a disciplined budget framework. We argued that otherwise runaway costs would demoralize citizens and undermine our country from within.  At that point total annual U.S. healthcare spending was 3.2 trillion dollars, amounting to 18 percent of GDP (2015 figures).

Where We’ve Come

Well, we’ve come to a projected total national health expenditure in 2022 of 4.45 trillion dollars, 19 percent of GDP.

And amazingly we’re still alive.

This, in fact, was one of the first lessons learned by this blogger, courtesy of economist Lawrence Summers (see “Paying for the High Cost of U.S. Healthcare,” March 2019).  Namely, that rising national spending for services, such as healthcare, was expected and proper in a post-industrial economy, and would not be deleterious so long as debt was managed responsibly.

Here are other key ideas explored by this blog along the way.

  • Healthcare, like many of the other institutions in the U.S., tends toward plutocracy, that is, governance by and for wealthy interests, not necessarily for its intended purpose of citizens’ health. (See “Healthcare Hits a Pothole,” July 2018)
  • Consequently, the distorted healthcare market in the U.S. results in prices that are double those in other developed countries. (See “New Data from AMA Journal” March 2018)
  • Powerful interests have employed divisive social-political messages to distract grassroots citizens from corrective checks and balances on their lucrative pricing schemes and on their control of the sector. Much of their disinformation and messaging has used race-baiting “dog whistles.” (See “Dog Whistles” April 2022)
  • Those divisive messages have also undermined support for public goods such as public health and pandemic preparedness, and have helped perpetuate social disparities that, in turn, negatively impact health, wellbeing, and longevity. (See “What About Free Riders?” February 2019)
  • Consequent mayhem in messaging, social psychologycivic cohesion, and actual health services is reflected in excessive death rates, notably among working age Americans. (See “Stalled Reform: Worse than you Think” August 2022 and “Cost-Benefit, System Reengineering, Both?” May 2018)

Where We Seem to Be Heading

Here are some indications of where we may be heading:

  • The Biden Administration has competently handled multiple simultaneous challenges – not always pleasing everyone or even themselves, but effectively enough to tamp down cynical nihilism. The Administration’s success has rekindled cautious hope for our Constitutional government of, by and for the People, including healthcare reform. (See “Biden’s Pandemic Response Plan” February 2021)
  • Discussion has emerged on ways to strive for a “more perfect Union,” that is, to build in mechanisms to learn and correct, not just to cling to past modi operandi. Recognition has also emerged that Reagan’s choice between big government and limited government, or between government as the problem or as the solution, is an overly simplistic and false dichotomy. Rather, debate is now over right-sizing government, over optimizing its effectiveness, and over synergizing public and private sectors, including in healthcare, in a complex fast-changing world.
  • There is awareness that large institutions – be they public, corporate, or non-profit – need transparency, orderly governance, and accountability. Investigative journalism facilitates these goals and helps to self-correct deviations. Healthcare institutions are no exception.
  • Meanwhile, the Federal Trade Commission is cracking down on anticompetitive concentrations of corporate power, including in healthcare (See “Can the F.T.C. Spur Healthcare Reform?” March 2022)
  • Meanwhile also Congress has for the first time stood up to Big Pharma by ending its sweetheart crony-capitalist medication deals with Medicare.
  • Congress has also now funded pandemic preparedness and Medicaid expansion in its final days of the 2022 session

And here are examples of other ideas recently floated:

  • Donald Berwick MD, former head of Medicare, writes in the AMA Journal recently that Medicare should be redesigned to optimize the public health of its beneficiaries, not just to serve as a fiscal intermediary. (See “Annual Summary” December 2020)
  • John Ikenberry, former State Department official and international policy expert, writing in Foreign Affairs, offers an optimistic paean to the United States’ unique vibrancy. Despite its recent “domestic convulsions,” it is on the path toward self-correction. And it will continue to draw on its idealism, its progressive impulses, and its already-successful multi-cultural multi-racial society (a “global republic”) to thrive in the next century as it works through its challenges including healthcare reform. (See “We Need Empathy, Not Just Ideas and Idealism” June 2021)
  • German Chancellor Olaf Scholz, also writing in Foreign Affairs, articulates an achievable vision of “a family of stable democracies enjoying unparalleled social welfare and public infrastructure.” These latter include equitable, reliable healthcare. (See also “Healthcare Reform & the Strength of Nations” September 2022)

Signing Off

And so, this blog signs off, recognizing that the U.S. has not reached the goal of universally accessible, costworthy healthcare. But this blog has grown more confident that a sufficient constituency now frames the project fully informed by eclectic viewpoints and shows willingness to address it in its full complexity.

Take Action

Readers are still urged to stay informed, stay engaged, and take action.

Image Credit

Title:  Lookout – Menhaden Fishing

By: University of Washington, Public Domain, via Wikimedia Commons


Updated January 5, 2023

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