Healthcare reform was a key voter issue for the mid-term November 2018 election. More than ever, America still needs the ingenuity of its people, along with renewed brotherhood, self-confidence, and devotion to our ideals in order to meet the challenge to controlling the runaway healthcare system.
Here are some key questions.
Purpose of Health & Healthcare
- What is the meaning of health? Is it just physical? Should it include mental health? What about social and family relationship health, and overall wellbeing?
- What is the purpose of healthcare? Is it just to maintain or restore ability to work? Or does it entail “pursuit of happiness” and societal participation? To what extent is the purpose to give health workers jobs or to earn profits for investors or researchers?
- Is healthcare a commodity to be sold commercially for profit? Or is it a “public good” that should be available to all and that benefits all directly or indirectly, like infrastructure, education and defense?
- Who should have access to healthcare? Should access be determined by income, ZIP code, health status, employment? Or should all citizens have access as part of the “social contract”?
- Should society provide for disabled? Catastrophically ill? If so, to what extent?
Paying for Healthcare
- Who should pay? Rich/poor? Healthy/sick? Young/old?
- How should we finance healthcare? Rely on employer-based insurance? Provide subsidized public insurance options? Fund a single-payer system with taxes?
- If we choose commercial insurance funding, what is the purpose? Is the purpose profit, cost minimization, or subscriber health? Should commercial insurance be non-profit?
- If we choose commercial insurance, may insurance companies exclude chronic care (pre-existing conditions)? Low-value services? Expensive services? Who defines “essential benefits”? Who ensures fairness?
- If we choose public financing (taxpayer-funded), how can we ensure accountability, transparency, performance?
Trade-Offs
- Is the for-profit “free market” more important than administrative efficiency? If so, is “free market” inefficiency worth the cost of a half trillion dollars, $1 trillion, $1.5 trillion?
- How to fund innovation and research? Set up research as public “moonshot” programs or competitive profit-for-risk-taking?
- What is economic trade-off between healthcare and other public goods? How to balance healthcare against education, defense, infrastructure, security, social order?
Only after there is sufficient consensus about these questions can ingenious healthcare professionals, administrators, and public policy leaders begin reforming the system.
Learn Civility and Peacebuilding
Visit “Reviving Civility” website. Recommit to civil dialog with fellow citizens.
Visit “Beyond Intractability” website. Hone principled negotiating skills and creative “systems awareness” thinking.
Stop blaming, and become part of the solution.
Take Action
The voters in each state have elected their representatives.
Do you agree that government of, by, and for the people needs to tackle real healthcare reform? Do leaders need to engage us to set priorities? Won’t all of us need to bend a little, and some bend a lot? What incentives will each stakeholder need to do our share? How could reform be done fairly and deliberately without excessive disruption?
Think about all of these questions, and tell your new representatives what you are thinking. Americans have work to do on a “more perfect” healthcare system.
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Fixing U.S. Healthcare 
