Once again, we are going through a struggle to limit health care spending. Oh, woe is us! What to do?
We can't control health care spending for a simple reason; we have a ridiculous health care system. Our fundamental problem is private health insurance. Americans cannot seem to grasp that private health insurance for health is simply stupid; people can't really limit their health care costs by living more prudently, or shopping for the best health care providers, or for the most efficient insurers. Everywhere else, health insurance is a government responsibility; indeed to call it insurance is a misnomer, it is social insurance for health, like Medicare or Social Security for the aged and other specific populations.
Government covers the amount needed to provide health care to a population with tax dollars, and budgets more the coming year as the population ages. Where those tax dollars come from varies, from Canada, to England, to Germany (I have visited and consulted with health experts in all of those nations, and others, including the Nordic countries).
Do these other nations have difficulty paying for these vast costs? Of course they do, but per capita they are much cheaper and they almost all have some simplifying elements. The most important of these is that the national program "buys" insurance from health insurance companies for cheaper than health insurance in the so-called competitive or private sector. (Actually the private sector is arranged so as to forbid government from bidding on the costs of health insurance from competing providers.)
Private health insurance is rare in most of these countries; sometimes it exists only to supplement and provide services not covered by a government plan. But in truth most citizens in most of these countries express strong approval of their health care and the system that provides it.
We, on the other hand, still worship at the altar of private enterprise; we spend barrels of ink each year talking about the waste of government programs. (As an aside, why don't we read more about of how much waste is found in competing private health care providers?)
Even today as we prepare to abolish Obamacare, for no apparent reason other than that its name is so odious to hardline Republicans, no one asks, "Why?"
Think of it; Obamacare insured millions of Americans previously left behind, cutting the ranks of the uninsured in half, to 8 per cent and the GOP hates this. So this must be erased.
I think I know why this fundamental fault line of worship for private enterprise exists in our body politic. We believe that by definition private enterprise is efficient and government isn't (at least in the sense 'efficient' is usually meant). This is true but this is a trivial point, actually. Efficiency in the usual sense mean "market efficiency" or the idea that competition forces corporations or companies to work hard to eliminate waste, etc., in order to win stockholder approval and to maintain or gain market position. We also believe that markets expand growth; government slows it.
These ideas are truly enduring canards or mantras which few American columnists ever challenge.
I just spent 10 days in the Southern AZ VA hospital for hip surgery and convalescence. The health care was outstanding; my surgeon was top notch; he 'screwed together' a fractured hip bone. The incision was little more than an inch in my hip. I didn't lounge around waiting for the nurses to appear; they got me up and on my feet almost before I knew what was happening. This is what good care is like.
The VA is financed by budgets; as a veteran I was never provided with a bill for anything....period.
Why do we in the U.S. ignore the VA's record? Why are we are repealing Obamacare and denying health care to millions largely because of the program's name and its origins with President Obama and the Democrats? The news media, including the New York Times, dutifully report this as news when in fact it is political insanity of the first rank.
We need a national health service, one operated like the VA, providing health care to all.
Sure, some people have had a bad VA experience. Bad experiences in any system are unavoidable when you spend billions on health care for several hundred of millions of people. Using private insurance to finance health care expenditure is simply insanity; it will never result in total expenditure levels for affordable health care for a nation for the simple reason that budgeting health care dollars with private health insurance means paying bills, not curbing waste and excess spending, much limiting the growth of total health expenditure. And on top of that we rank something like 37th in life expectancy among the developed countries of the world.
Wait until this next Republican insanity to replace Obamacare is concluded and then watch as private contributions to campaign funds for GOP members (and some Democrats) grow apace. We likely will never learn, not in my lifetimes. Our private health insurance/ provider system is bankrupt and few among leading journalists or editorialists will say this out loud, again and again, until enough of us finally say, "no more." (Paul Krugman is the major exception.)