May 27, 2018
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Health Care Values

America’s health care system is at odds with the country’s values, Newsweek columnist Jacob Weisberg argues in a recent edition of the magazine. His prescription for realignment is one lawmakers should consider when they return to Washington to hammer out details of health care reform legislation.

First the diagnosis: Our system, which is expensive and individualized, is uniquely American, for good and bad. “Health care in America is innovative, entrepreneurial, expensive, litigious and wasteful,” Mr. Weisberg writes in the July 27 magazine. “It is decentralized, driven by self-interest, excellent at the high end, and increasingly unequal. It resists acknowledging trade-offs or limits and is characterized by shocking gaps in basic care.”

But, our health care system doesn’t mesh with American culture in three respects: moral, economic and sociological.

On morality, although Americans are more accepting of inequality than Europeans, the type of unfairness in our health care system should raise alarms. “The random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the national conscience,” Mr. Weisberg writes.

He gives the bill supported by House Democratic leadership good marks on this score.

Financially, the United States’ system is expensive and wasteful — and we don’t seem to care. “We’re a rich country and want the best care available,” the column continues. “But we need to recognize that we’re getting a crazy, bad deal by spending so much and leaving so many people out in the cold.”

Unfortunately, the bills under consideration don’t have many teeth when it comes to holding down costs. This is an area where lawmakers should spend a lot more time. Without mechanisms to reduce costs — yes, many of them will be unpopular — reform legislation will be bogged down by concerns that any changes will run up the deficit without enough offsetting benefits.

The sociological misalignment may be the hardest to change. Although we are a highly mobile society — Americans change jobs, on average, 11 times before the age of 40 — we rely largely on a health insurance system designed during World War II. Rather than increase wages, employers offered health insurance as an inexpensive benefit. It is no longer inexpensive, but health insurance is still tied to employment for working-age Americans.

“Fear of losing health coverage keeps people in jobs they would otherwise leave, creating a drag on economic efficiency,” Mr. Weisberg notes.

The prescription, he says, is a bill sponsored by Oregon Democrat Sen. Ron Wyden, which would give a tax credit for employer-provided health insurance and require people to use it to buy insurance. It also contains cost controls.

This, and other proposals that meet our moral, financial and sociological obligations, are worth close examination.

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