Healthcare: What Next? Circle Up Around This

With the political failure on the part of both parties to sort out what to do about the Affordable Care Act, perhaps this is the worst time to bring up healthcare reform. As a nation, we cannot even decide how to deal with the limited healthcare policy issue now known as "Obamacare". 

My observation is that the failures around Obamacare were purely political in nature, a product of the divisiveness in today's discourse spun from splintered and polarized interest groups. As noted in the powerful and insightful book by Senators Trent Lott and Tom Daschle about the rupture the fabric of American politics, "Breaking Point"; this fabric has come unraveled and regard for facts has been discarded in favor of "alternate facts" that suit our own particular points of view. 

The polarizing rhetoric around Obamacare followed a similar pattern. The left and right squared off around the political divisions around healthcare as a right versus healthcare as a privilege, and about spending priorities around social welfare programs that recall the lectures in our Economics 101 class, the "guns or butter" paradigm. Without any common ground between these conflicting politics, there is no way forward on framing an agenda to solve the "ObamaCare problem", so forget healthcare reform. 

However, if we pause a moment to reflect on the disenchantment with American government, we notice that "kitchen table issues" of jobs, incomes, and affordability are often the driving forces behind much of the political posturing. If good jobs were in ample supply, and if there was enough money to go around to train and prepare people for the jobs in the "new economy", and we did not have to spend so much on healthcare, we would all be in a very different political environment today. But of course, this is not the reality. Yet if we could agree that these are high priorities, no matter on what end of the political spectrum we find ourselves, we might have a strarting point for a civil conversation. 

My opinion is that we could begin having that kind of conversation if we begin with some facts that are not very controversial. First fact, healthcare in the U.S. costs way too much. Second fact, because this is true, it sucks up resources that could otherwise be used to pay for other things we individually value and would choose to invest in, depending upon our personal situations. This is the beginning place for a way forward. So, let's start here. 

Several years ago, there was a populist politician whose campaign motto was, "The rent is too damned high!" He brayed this phrase every time he got an audience and was well received for his simple and obvious complaint. Of course, what to do about it was the tricky part. Like him, however, we should be able to gather support for the idea that the cost of healthcare is also "too damned high!" 

The cost of healthcare in America averages twice as high as the cost for developed nations (OECD, the Organization for Economic Cooperation and Development). We spend 18% of our economy on healthcare while they only spend 9% on average. This 9% gap translates into an extra $5,000 cost per year per person in America. If you have a family of three, what would you do with an extra $15,000 per year? 

For many people, the extra money would go a long way towards making ends meet. It would leave a lot more money for the basics of life, and for those planning to invest in a college education or retirement funding, it would be huge. Naturally, not all of that extra money would go directly into our pockets: governments would take a bite out of that for taxes, of course. However, that extra tax revenue would reduce the pressure to raise taxes. It would help stabilize the social programs such as Medicare trust funds, Social Security, and more. 

More than that, if healthcare costs were reduced so dramatically, employers could afford to pass along wage increases that are currently devoured by sky high healthcare insurance costs. For the first time since the early 1970's, real wages could go up instead of sideways or down as they have for the last 40 years. While productivity of U.S. workers has continued to climb, we have not seen the real incomes of workers increase at the same pace because healthcare inflation stole that away from us. 

Once you get this picture, you realize that rising healthcare costs have been a tax on the American economy, holding back wages, pensions, 401(k) retirement savings, education, and more. Because of the high costs, we have not been able to afford to give everyone access to healthcare even if we wanted to. And those without healthcare have still gotten sick, and unable to pay for emergency services, their unpaid bills have been passed along to us in the form of tax write-offs by uncompensated healthcare providers. Beyond, that, unhealthy people have not been able to contribute economically to society by being fully functioning workers and tax payers. This is truly a sick cycle. 

As we know, consumers drive our economy. Imagine everyone had an extra $5,000 to spend on what they valued most. Some would save and some would spend. Think about the spur to the U.S. economy. Yes, high cost health care is a big drag on the economy. Without it, there would be more jobs for everyone. Let us take a moment to see how much agreement we still have among all Americans once we arrive at this point in the argument. I think we should all be in alignment, so far. 

Now, while it is true that some people in America have the best healthcare in the world, it is also true that access to that kind of care is not evenly distributed. As a result, for all the money we spend on healthcare, the outcomes of our healthcare system are among the worst in contrast with the OECD countries, when averaged out across the U.S. So, not only is our healthcare the most expensive, but it is also one of the worst in the world. There are no credible arguments against these facts. 

Let's circle up now around these core issues. Let's put behind us the divisive philosophies or political positions for a moment: can we agree that we all want and could do with much more affordable healthcare? Do we agree we want to get better value from the healthcare we receive overall? Is this common ground? Unless we can circle up around this, we will never find a way forward, but if we can, a way forward is something we can begin exploring.