On and on it goes. The nation’s healthcare reform debate rages on as the primary item on the local and national agenda. And while most conversations on healthcare generate plenty of “heat”—sadly, the discussion has yielded far less “light.”

 

Every single one of us is affected by healthcare—whether we are well or ill, take good care of ourselves or are careless, insured or not, well-off or poor. So, too, our national economy suffers in terms of efficiency and effectiveness with a healthcare system responsible for over 17.3% of our Gross National Product and growing uncontrollably.

 

Despite the apparent gridlock in Washington on the structure and direction of healthcare, two relatively simple changes can make a world of difference in our nation’s collective health. And lest you think this healthcare dilemma is a new 21st-century problem, it’s not.  

 

History repeats itself and today’s healthcare debates are no exception. This country has been debating healthcare reform for a century.

• The movement for national health insurance and expanded coverage began in the early days of the 20^th century. Theodore Roosevelt seized on the issue when campaigning on the Bull Moose Party ticket in 1912. The issue was promoted by progressives in 1914 and 1917 and the 1920s, according to a 2012 New England Journal of Medicine article.      
• The Great Depression renewed interest in the concept with President Franklin Delano Roosevelt supporting national health insurance. But, because of intense opposition from the American Medical Association (a recurring theme throughout the last century), Roosevelt feared the whole Social Security bill might be defeated. So, he postponed the issue. Roosevelt died in 1945 before he could resurrect the plan.
• President Harry S. Truman formally proposed national health insurance, but the proposal died because of a mix of influences, including party politics, cries of socialized medicine, and even segregation.
• Thereafter, major overhauls were proposed or seriously considered by seven Presidents— John F. Kennedy, Lyndon Johnson (who managed to get Medicare enacted), Richard Nixon, Jimmy Carter, and Bill Clinton. Ronald Reagan pushed for catastrophic Medicare coverage and President Clinton made an ill-fated attempt at health coverage for all Americans. Finally, President George W. Bush endorsed tax credits as a means of expanding coverage.

Why is the situation so urgent today?

 

For one thing, the effects of globalization have accelerated our need to change. As U.S. health costs rise out of proportion to our international peers, American companies become less competitive economically. For example, health care costs American automakers about $1,500 per vehicle produced, while international manufacturers spend only about half that amount. Manufacturing is down because healthcare costs are up according to an Industry Week article.

 

Then there are the steadily mounting costs in the form of U.S. government liabilities from contractual commitments to retired employees for healthcare. Such costs could make health care a terminal illness for America’s governments and businesses, according to Clayton Christensen’s The Innovator’s Prescription.

 

Healthcare economist Victor Fuchs is even more dire, contending that we will see major reform only in the wake of a war, large-scale recession, or large-scale civil unrest. We have had 13 recessions since the 1940s. The point is that dollars spent on health care come out of wages. A doubling of healthcare costs would be catastrophic for individual incomes.  

 

So we’ve got to reform our healthcare system. That’s clear. The question is, “How?”

 

Most of the discussions so far have been partisan and polarizing, focused on payment mechanisms and protecting one’s own “turf.” Most insurance companies, big pharmaceutical companies, device manufacturers (e.g. pacemaker and artificial joint manufacturers, etc.), hospitals, and physicians prefer the status quo. They are mostly “change-phobic.”

 

But two simple changes provide a wonderful opportunity both to change the system and improve individual health at the same time. These two changes would improve quality, decrease costs, and do nothing to interfere with the traditional physician-patient relationship.

 

Sounds too good to be true. Not really. Next week we’ll delve into evidence-based medicine.