The most recent attack on our present health care system brings up, one more time, the fundamental issue of whether health care should be available to all as a matter of right. This question, instead of being seriously faced in open debate, has been tossed around as a political football for many decades in the United States. Language has been abused, on both sides, the left with the call for a single payer system and the right with the call for a block grant system, to avoid serious debate. Nothing would illustrate this point more than to ask yourself whether you understand how each position would function. I do not know, and I think about it a lot.
As is true with practically every political issue we face today, we need first to state our basic goal, and we need to state that goal openly. Here is my little effort at doing that.
First, I put it as a moral issue that, being grounded as we are in the commitment to the inalienable rights of all human beings, we must, insofar as we are able, provide every American with basic health care.
Second, it is clear that, whatever system we employ, it must do two things: operate efficiently and reduce the cost of health care in America.
Third, it is equally clear that, all other things being equal, private industry can accomplish tasks more efficiently and more effectively than government can.
Given these three principles, I conclude that we should have a system that provides basic health coverage to all people, and that that system should be run by private insurers. I therefore conclude that what we need to do is, first, define what “basic health care” means. It is neither Cadillac care on the one hand nor aspirins for everything on the other.
Once we have figured out what we mean by basic health care, then we should provide that care to every American through a system run by private insurers. My suggestion is that we divide the whole country with a grid, and then auction off each grid to a private carrier. The winning bid gets a monopoly in the section it has successfully bid for, and a public service commission is charged with controlling the cost charged by that insurer to avoid gouging. Then we grant these private carriers the right to negotiate with medical providers for the lowest prices for care and for medical products, particularly drugs. Finally, since we have now provided basic health care for everyone in the country, we remove health care provisions in all other insurance — auto, products, homeowners, etc. — and we remove medical expense as an item of claim in various legal actions. So we eliminate subrogation, and we remove medical expense from all forms of personal injury claims. This last action will significantly slash the cost of liability and worker’s compensation insurance across the nation, thus taking a burden off employers so that they can be more competitive in the global market.
The devil being in the details, adopting this plan would require much research and debate. But it would be honest research and honest debate, because we would not be hiding our real reasons for holding the positions that we do. It is that business of hiding our real goals that makes rational debate impossible and shouting and ridiculing necessary.
I may be wrong about the efficacy of this proposal. What I am not wrong about, and what is desperately needed in our political arena today, is that we must first, openly and clearly, state our real goals. If we did that, I would bet that we would find much more agreement among the competing sides that we think exists. Most Americans agree on their first principles. Given that, our discussions are simply about the best means to serve those principles.