Healthcare reform was a key voter issue for the November 2020 election. More than ever, America 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 costs in the healthcare system, but also to ensure equity.
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?
- 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?
- 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, environment sustainability?
Only after there is sufficient consensus about these questions can ingenious healthcare professionals, administrators, and public policy leaders begin reforming the system.
As a new President and new Congress take office in 2021, think about these questions and tell your officials what you are thinking.
Do you agree that government of, by, and for the people needs to tackle real healthcare reform? Do leaders need to challenge all of us to set priorities and tame the healthcare tapeworm? Won’t all of us need to bend a little, and some bend a lot? What incentives will each stakeholder need to do so? How could this be done fairly and deliberately without excessive disruption?
Meanwhile, can healthcare reform be adequately addressed in isolation from the other pressing problems of our day – education, housing, jobs, immigration, global pandemic preparedness, climate policy, and racial disparities?
Americans have work to do on a “more perfect” healthcare system.
Image License: Permission is granted to copy, distribute and/or modify this document under the terms of theGNU Free Documentation License, Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts. A copy of the license is included in the section entitled GNU Free Documentation License.