Thursday, March 23, 2017

Our Lopsided Healthcare Debate

The United States is the only Western Democracy with “winner takes all” elections. Other democracies have proportional representation that accommodate numerous political parties. I’ve been wondering if the deep divisions among both the Dem’s and GOP is a forewarning of our need to upgrade our structuring of legislative bodies at the Federal, State and Local levels.
One price we pay for “winner takes all” election outcomes is lop-sided debates that over-emphasize political agendas and neglect comprehensive policy concerns. It appears we cannot have both so political victories become the top priority. Solutions where we can have both sides of contentions work much better. These winning combinations realize the best of both stances. They are self-regulating and self-equilibrating. The deliberations are balanced and inclusive. The diverse constituencies appreciate the legislative outcomes. Policy issues that have been overlooked or excluded get factored into more complex formulations of policy.

Looking through a system lens at this, hybrid systems function much better than opposing systems. They “raise the water level and float all the boats” instead of favoring one side over the others. The lop-sided healthcare debate would be upgraded by hybrid systems for each of the following:
  • Private sector and Public sector involvement, contribution and protections
  • Top-down/centralized and Bottom-up/distributed power, control and discretion
  • Federal and State levels of decision-making, prioritizing and spending
  • Short term fixes, heroics, crisis management and Long term investment and cost-savings
  • Politically-driven and Policy-driven concerns, interests and agendas
  • Urban and Rural constituencies, issues, and policy impacts
  • Advantaged-contributions and Disadvantaged-dependent participations
  • Medical outcome priorities and Economic sustainability priorities
  • Innovation, creativity, experimentation and Safety, security, continuity issues
Germany has a hybrid healthcare system where 85% of the population subscribes to the government single payer system and 15% have a choice of private insurers. The public system is equal to or better than the private system on many outcome measures. It does not fit the pictures of GOP lawmakers who imagine endless lines, long waiting lists and inadequate care if bureaucratic care overtakes private providers. The experience of Germany highlights some of the issues absent from our current healthcare debate.

The GOP believes the only way to control healthcare costs is to ensure marketplace competition. They are afraid of a “lack of choice” due to a single monopoly provider or no provider at all. The “implosion” and “complete disaster” labels applied to ACA reflect this lop-sided faith in marketplace competition. They cannot consider or realize they are missing:
  • A single payer system aggregates demand and purchasing power which enables negotiating for lower prices from drug and medical service providers.The less gigantic private insurers lack this purchasing power. (Medicare and Veterans Administration do this now)
  • A single payer system eliminates transaction costs that private insurers escalate. Doctors become experts in which insurer offers which benefits. Patients struggle to compare insurers with dozens of plans, deductibles, copays and premium schedules. (Kaiser Permanente attracts numerous physicians from private providers with their freedom to focus on caring without insurance hassles)
  • Limiting coverage is essential for private insurers to make a profit. A single payer system takes coverage issues off the table. Every citizen is covered, not merely given access or choices they dislike or cannot afford. The aggregation of risk makes this financially feasible. Rather than establish health insurance as money-making enterprises, public insurance delivers guaranteed coverage of medical costs at the cost to the non-profit provider. 
  • A single payer system only manages the aggregation of risk, reimbursement to providers and collection of premiums. The medical services remain private enterprises in competition and rewarded for providing more and better services, preventative care and coordination between specialties.  Rather than becoming more profitable at the expense of patients, they earn high ratings from patients for improved responsiveness, communication and access.
A “single payer” system is a misnomer. Insisting “healthcare is a right” is a weak argument. Single payer is really a hybrid system which rewards every component for its participation, cooperation and contributions. It realizes the best of both public and private approaches to policy, enterprise and governance. If our healthcare debate was not so persistently lop-sided, the reasoning behind 27 other countries deployment of a singe-payer system would enter the deliberations and policy formation. 

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