Friday, March 7, 2008

Next Constitutional Amendment: Right to Reasonable & Quality Health Care

Health Care has emerged as one of the top issues in this year’s presidential election and taken up some bandwidth of the airwaves and candidates. At end of the day though, I predict it will end up being “the NEXT most important issue” as before and no material reform will take place anytime soon. What is disturbing is that while the symptoms of the sickness of our health care system have been so visible and real for so long, this most wealthy and dominant nation seems paralyzed and helplessly watching the problem continue spiraling out of control despite decades of efforts by many. It got so bad that film maker Michael Moore could produce a box office hit with dramatic heart-felt stories and extreme contrasts of different countries’ systems in his recent documentary movie Sicko. Of course, Michael Moore did not offer any real solutions.

Like many others, I found myself increasingly concerned about this issue and being an optimistic cynic, I decided to take a look if there are some hopeful signs of solutions on the horizon. As I plowed through numerous study reports, domestic and international historical and projected data, wide ranging and conflicting opinions, debates, recommendations and proposals, I began to realize this problem is like Gordian Knot that one can easily be trapped and confused forever in attempting to address it with different approaches under varying and often vague assumptions. The solution to Gordian Knot is of course well-known: take a bold move and do not be confused and distracted by the appearance of complexity.

So let us start from the very basics and first agree on a common goal and set of assumptions and facts. I would submit that as decent human beings of a civil society, we must commit to each other that every life must be treated with dignity and should receive needed and appropriate preventative and remedial health cares, be it short or long term. Thus my definition of the illusive term of Universal Health Care would be: Regardless of one’s gender, race, age, religion, occupation, income, residence, legal status, etc., one shall have the right to reasonable and quality health care. By reasonable and quality care, I mean a consensual judgment and expectation by well-trained medical professionals, based on science, technology and quality of life considerations, of needed proper health education and treatments. Of course, with rights, there come with obligation and responsibility that includes becoming more knowledgeable about our own bodies and keeping ourselves healthy through e.g., proper diets (yes, health system is directly connected with our food system) and physical/mental activities. We don’t need to elaborate these further.

Once we agree on this goal, we can inoculate ourselves from those who try to divide us and pit one against another - the old vs. the young, the sick vs. the healthy, the insured vs. un-insured, the rich vs. the poor, the workers vs. unemployed, and the legal vs. unauthorized immigrants. We can begin to debate what is the best way to finance and sustain a grand enterprise that takes us to that awesome goal. I am convinced that the financial obligation of universal health care must be met completely and unequivocally through individual and business taxes. It must not be left to individuals and business to cherry pick when and how much they want to participate based on their own immediate benefits and try to shift the burdens to other. In return, individual will no longer have the fear for lack of care when they need it the most and when they are vulnerable. At the same time, business can be assured of well-cared work forces in the society and concentrate on their real business without being dragged down by adversarial relations with employees and unfair health care cost.

One might wonder if such fundamental change of the finance will increase the total expenses of the health care or re-distribute the cost to different groups. I don’t think so and here is the reason. The government official statistics tells us that the total U.S. health care expenditures was $2.1 trillion in 2006 or equivalently, $7,026 per capita or 16% of our Gross Domestic Product (note while it is the highest of all nations in absolute dollars and in % of expenditure, we need to be careful in interpreting this data as it does not necessarily suggest by itself something is really wrong – a separate topic by itself). Out of this $2.1 trillion, about $970 Billion or 46 % was due to public health care programs such as Medicare (for elderly) and Medicaid (for low income families) which are already funded through taxes.

Further, in terms of coverage of population under some forms of insurance, a 2007 U.S. Census Bureau report tells us that out of the 300 millions of people public health insurance programs cover about 80 million of us. There are about 180 million people are in employment-related insurance plans including 50 millions of them are under self-insured employer plans (yes, you may not be aware of the fact that most workers and their families of larger companies and organizations are NOT insured by private insurance policies!). Employers have always considered some (or all) of employee health care cost as a part of cost of doing business. I am asking the business to pay the same amount as tax instead to a “Universal Health Care Fund” that will finance the delivery of the cares and services. Then there are estimated 40-50 millions of uninsured people whose expenses when unpaid, have always been covered by the governments at all levels with good wills of our tax dollars. Thus, I don’t think anyone needs to pay more than what they are already paying. In fact I am expecting the overall longer term cost would go down because cares through emergency room is the most expensive form of health care delivery and because efficiency can be realized with well-designed balancing forces and competition. One thing we must bear in mind however: Universal health insurance coverage is NOT equal to universal health care and should not be the goal. In fact, there are about 16 millions of insured people (so-called under-insured) who do not have adequate coverage and protected. Worse yet, since most of the 180 millions of people and their families are covered under employment-related insurance plans, many of us fear for changes or loss of jobs that carries potentially devastating consequences.

The next key issue is to design a system consistent with our economic principles such that quality and level of health cares would be positively and strongly correlated with the amount of resources we are willing to put in. There are so many smart people who have studied this issue and can help create a competitive private or mixed public and private system that supports the universal health care goal. For example, in a 2006 article, well-respected Professor Michael Porter of Harvard Business School has articulated what is wrong with our current system and has proposed a value-based competition system based on results (yes, he means results, not process). Note that he also emphasized that for such a competitive system to work, it must be mandatory and universal to begin with which I agree completely.

I can imagine, starting with these sound principles, we will end up having competitive health care delivery and services of hospitals, clinics, doctors and nurses that are sustainable because they deliver quality care more effectively that (available) money can buy; we will have profitable world leading pharmaceutical and medical technologies companies that invest on research and development and shrive on producing price competitive new drugs/instruments/tools as well as cost-reduced mature products and tools; we will have medical schools and research institutes that earn their reputation and endowments by advancing the knowledge in medical sciences, attracting and nurturing the best practitioners and researchers with strong skills, ethics, morals and social responsibilities. We will have efficient and coordinated payment systems by service providers that compete on price, quality and efficiency and build on experience and expertise of serving those 100 million of Medicare, Medicaid and self-insured employer program participants.

Eastern religions and philosophies have long considered Birth, Aging, Illness, and Death significant phases of our lives. If we can handle these issues with a sound health care system that free us from fear and anxiety, I think we would be close to be living in a paradise!

Talk to you soon!

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