Complex problems really can’t be solved with simple answers. And few problems are more complex than providing health coverage and care for the large and diverse American population. American healthcare costs trillions, about $3.6 trillion in 2018 when you add in everything from doctors and nurses to computers to ambulances to drugs to administration to insurance processing… The list is very, very long.
There are approximately 330 million Americans, and all of us need care at some point in our lives. Almost 50 million, approximately 17 percent, are above the age of 65, according to the U.S. Census Bureau, and presumably need more care. So money is never not an issue.
Even more important, health and illness affects all of us. Perhaps you are not grappling with health issues at the moment, but 57 percent of Americans say that they, or someone in their household, has a pre-existing medical condition according to the Kaiser Family Foundation.
But sometimes we can begin solving complex problems by asking the right, simple questions and seeing where the conversation takes us.
Here are three simple questions that can start the right conversation about health policy, and that may even lead to solutions.
What’s worth paying for?
Is there a limit to the care an individual should receive? According to the Center for Medicare and Medicaid Services, approximately 30 percent of Medicare spending is done in the last year of life, although some studies put that as low as 10-12 percent. Still, should a 95-year-old man receive surgery to stent a blocked artery? The answer may be “yes” or “no,” but it’s worth talking about. Should cancer patients receive chemotherapy that costs $500,000 per treatment? Should smokers have equal access to care? Until we have an open and honest conversation to resolve such difficult questions, we will never get to the right policy.
How much should we pay?
Once we decide what is worth paying for, we have to figure out how much we can afford to pay. Our taxes have to pay for many important things: roads and trains, the military, clean water, scientific research, and so on. Healthcare is one of those important things, but only one. So how do we get as much healthcare as we can at the highest quality at the best price?
Some nations choose to have very high tax rates as a means of ensuring health coverage for everyone within their borders. These countries tend to establish greater governmental control over the cost of care, including clinician salaries, pharmaceuticals, medical devices, administering insurance—the whole panoply of healthcare spending. That is a rational choice.
Some nations maintain low relative tax rates and expect the individual to have a larger share of responsibility for paying for healthcare. These countries leverage market forces to achieve lower costs. That is a rational choice. The important thing is to make conscious choices through reasoned discussion, and not let past practice determine the health of our nation.
Who should pay?
Resources are not distributed equally to every individual in our society, nor should they be when capitalism allows for the creation of wealth. But in our discussion of what is worth paying for, we have determined the public good of healthcare is paid for by taxes. How high should taxes be? Can a higher tax rates reduce individual spending on healthcare? Should everyone pay into the healthcare system, even if he or she is not ill, or should healthcare be structured more through user fees than taxes? The progressive tax rate has generally worked well in this country to both preserve individual wealth and pay for public goods— but only when taxes follow serious discussion about policy priorities.
What’s worth paying for? How much should we pay? Who should pay? By addressing these three questions we may get past the toxic rhetoric that has poisoned healthcare policy discussions. With 35 years’ experience bringing the right people together to have meaningful conversations that lead to change, I’ve seen the power of asking the right questions.