This from an actual bumper sticker: “HEALTHCARE IS A HUMAN RIGHT.”
Well, darn right!
If there is one thing a civilized society can do is guarantee everyone free access to medical care, as needed. Most so-called “First World nations” do.
Not here. Not America. Not yet.
When you need it, nobody doesn’t want medical care. It’s not the strongest bargaining position, the unshakeable possibility of direst need. It’s the threat that drives the medical insurance industry. When the threat of not getting care is compounded by astronomical retail costs for care, the logic of insurance, and the profits of the insurance companies are enhanced.
And when the costs for actual medical services – from physicians to medical centers, from Hepatitis C cures to digitally managed prosthetic devices – go crazy, all the providers get a cut – manufacturers, retailers, healthcare systems, insurers and brokers. Which is as good an explanation as any for why health care costs in the United States always seem to rise faster than overall inflation.
This is a need-driven free market in which the customer, the consumer of healthcare or insurance, has no power at all. And one thing we all know about free markets – power is usually expressed in price. The less you have, the more you pay. Or put differently, the less you pay, the much less you get in care – while the more you can afford, the much, much more you are afforded by the American way of medicine.
The counter to this is the so-called single-payer system in which the presumption is, if all medical services are purchased by one big buyer – the government – the power will shift to the buyer who will negotiate better prices and save customers money.
So-called “buy-in” reforms, the public options, cede part of the medical economy to the private sector. Competitors for individual coverage, or marketers of supplemental coverage can sell the idea that a second payment after the “single” tax-based one, will get you more, better, faster or more comfortable care. But they probably only hedge, the price-reducing bargaining power of the public system.
But there’s more to medical care than price, and reform plans need to think through hard questions like who gets coverage and for what and whether customers should contribute some form of co-payment.
So far, the Democratic aspirants for the 2020 presidential nomination have been more emphatic about offering more services to more people – maybe even all services to all people – than explaining how this will be paid for.
Shifting medical costs from individual citizens or employers to the national tax base is a big idea hiding a host of smaller, but crucial questions of how costs are apportioned and the quality of services assured.
Colin Baillio is Director of Policy and Communications at Health Action New Mexico, and a leading advocate for health care services in the state, improving the options for individual New Mexicans in getting the best medical care possible for their dollars.