The debate about the reform of US Healthcare has been going for a long while. Since president Obama took office in Jan'09, one of his priorities was to reform the US healthcare system and rightly so!
There is no doubt that a system which costs 18% of the GDP (twice as much as the utterly expensive French healthcare system), leaves 45 million people un-insured or under-insured and gets the US (the richest country on the planet) to be ranked 37 in quality of care is in deep trouble and should have been reformed long time ago.
The reform of healthcare is a multi-faceted issue that has to be examined from an economic, social and political perspectives. There are many stakeholders with conflicting needs and motivations. This small essai does not pretend to address the complexity of the problem! It only tries offer a different perspective to look and analyze the problem.
The critical question that needs to be answered by the American people is the following: "Is healthcare a merchandise or a right"? In other words, can healthcare be treated as a car or
an ipod or a computer where you can have it if you can afford paying its price? Or is healthcare
a right in which case people can have it every time they need it regardless of their capacity
to afford its price?
The prevailing opinion in the US Today is that healtcare is more of a merchandise. Hospitals, clinics, medical institutions and insurance companies are all in the business of healthcare to
make money and generate profits.
If we look in Canada and most European countries, healthcare is considered more as a right to citizens and residents. Even in the United Kingdom, it is the government who manages healthcare through the National Health Service. While differences do exist between the healthcare systems in these countries, they share common aspects: The government is one provider of healthcare (and in most cases a "significant" provider) and the system covers almost
all citizens and residents of that country (universal healthcare).
The reform of US healthcare system should start by operating a gradual shift in the "classification" of healthcare from a merchandise that can also be offered to those who can afford it to a right to those who need it.
As that shift is taking place, economical and financial aspects of the reform shall also be addressed. There seems to be a consensus that the reform will in the mid/long term provide
substantial savings to the federal government while expanding coverage to more than 95% of
US population.
The reform shall also contain provisions to simplify and streamline the way the delivery, the processing, the billing and reimbursment of healthcare are managed. A significant waste exists today that is costing hundreds of billion of dollars (about $400 bn in 2004) without adding value.
The reform of US healthcare system is a past due one and is needed for economic, financial, social, political and human reasons.
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I'm not against seeing Healthcare as a product, as soon as regulations, subventions or incentives make this product widely available ... because ok, yes, I agree that there is a right for a minimum Healthcare. The problem today is that even if you see it as a product it is a bad one, and in a bad market.
ReplyDeleteOne example: Food.
Everyone should have the right to have nutritious meals. It's mostly achieved in the US (with government incentives like food stamps and non-profits). It's also a product and has a market. But it's a good market: competitive and transparent. If I buy an orange, a) I chose the distributor, b) I see the price before consuming, c) I chose between alternative products.
Think how ridiculous this is:
I'm hungry, I go to get food to the nearest supermarket, they make me wait first and I get more hungry, then a nutritionist paid by the supermarket sees me and tells me I need an Mediterranean Orange, he is the expert so I believe him, and makes me eat it; Two weeks later I receive a bill for the Mediterranean Orange (and the nutritionist).
No choice, no alternatives, no competition, no price transparency! What a market!
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ReplyDeleteCristian, I like your comparison. As sad as it might look, your example is very eloquent and right to the point.
ReplyDeleteI'm for more transparency into the true cost of healthcare. And I agree, competition means choice and quality. Let's even the play ground and let the best win (Que le meilleur gagne).