You don’t have to be an expert to see that the current legislative process to address rising healthcare costs is broken.
I have had the opportunity to lead business and military teams over the course of my career, and I can safely say that when participants don’t feel like they have a voice, they withdraw support in small but important ways.
Therefore, I’m going to go out on a limb and predict that as long as we continue to see straight party-line votes coming out of Washington, where zero members of the minority party vote for a bill, the current healthcare debate will continue as a political game rather than a path toward healthcare policy improvement.
All of this masks a deeper problem, which is that we’re spending our time debating the answers without agreeing on the questions. It’s astounding to me how much of the news coverage clearly demonstrates this. So let me pose some simple questions for us all to consider:
In a modern society, should a developed nation provide basic healthcare services for its citizens? At what costs? How can citizens be encouraged to be smart consumers of healthcare services in this, or any other, system?
Since different healthcare systems in many other countries have been operating for years, how might we use the mountain of available data for our benefit?
When we’re evaluating the impact of a proposed bill, do we collectively acknowledge the Congressional Budget Office (CBO) as the most trustworthy source for estimating its long term costs and implications? If we ignore the CBO, what is our single version of unbiased truth?
If, as many believe, rising costs are largely driven by a combination of pharmaceutical market power, hospital consolidations (also market power), and an coding and billing process designed to be incomprehensible, then why do we spend so much of our energy having emotional debates about access to insurance?
If employers think that healthcare costs will continue to rise while the governmental focuses on insurance access rather than addressing the sources of rising costs, how will that impact their planning for new facilities and additional hiring?
Why, apart from New Zealand, is the United States the only country in the world to allow advertising for prescription drugs? How does this contribute to healthcare costs? What other negative impacts might such advertisements have on a country?
Should major social legislation become law if its unable to attract a reasonable number of votes – say 10% of the votes – from the minority party? If a bill passes based on a straight-line party vote, as happened in the Senate in 2009 with ACA and happened again this month in the House with AHCA, how likely is it that broad sections of the country will view that process as legitimate?
Both parties have core constituencies of “true believers”, meaning the people who are emotionally and financial supportive of the most conservative or liberal elements of their party. What role do these citizens play in the current debate? When is it more important to support your country over your party?
If you’re a true believer, is it possible that your party holds the shining truth about healthcare, while the other party is grossly irresponsible and doesn’t care about, say, poor people, or healthcare choice?
If you’re a True Believer, is it possible that the other party makes their decisions based upon greed and campaign contributions, while yours is driven by nobility and virtue?
If one party pulls a complex legislative maneuver to avoid needing even a single vote from the other party to pass legislation, what does that tell us about the bill itself? What does it tell us about the opposition?
What is the importance of longer term healthcare predictability? If citizens and employers are unsure of how the healthcare system might work in a few years due to the upheaval caused by some future election, how might they spend – or not spend – their resources today?
If we keep asking the wrong questions, we’ll keep getting the wrong answers. U.S. healthcare expenditures consume an enormous share of our enormous GDP, and continue to rise. If we want our spending (and outcomes) to be more competitive with other developed countries, we’re going to need to have a more serious debate about many of these questions.
Published May, 2017