I respectfully disagree with my friends and colleagues who believe that the recent financial crises will make it more difficult to reform health care. In fact, now that we’re socializing large chunks of the financial system, we may find it a lot easier to socialize health service delivery assets, too. You’ll know a federal health system bailout is around the corner when you hear someone say, "The hospital is simply too large to allow it to fail."
Let me explain.
In the past three weeks we’ve all become regulators. Amazing. Almost overnight the federal government, we the taxpayers, have taken ownership of Freddie Mac and Fannie Mae, financial organizations that own about half of the mortgage debt in this country. We’ve nationalized AIG, one of the world’s largest insurance companies, and we are now owners of a large share of several of the country’s biggest commercial and financial banking institutions, with much more government transfers anticipated in the coming weeks and months.
We’re doing this in order to restore balance to an economy that has been ravaged by unproductive, wasteful investments made by a hand full of powerful, unscrupulous people who have acted under the banner of the "free market," claiming it as the best way to secure economic growth and well being for the country and our population. Exposed now as a rogue ideology, its policies linked to the steady deterioration of the physical infrastructure of the country — our roadways, bridges, water systems, sewage plants, and so on — the mood of the country has dramatically changed and people are saying "Enough!"
The speed of this shift from tolerance of reckless and unregulated investment, to demand for close public supervision, is a signal that the game has changed and a new era has begun. In this new era, there could be spillover to other areas of the commonweal; people’s attitudes about how best to run health care could change quickly, too.
The parallels are obvious. We have a allowed a small cartel of wealthy and wealth-seeking individuals and organizations to invest enormously and in an unregulated manner in hospital, medical device, pharmaceutical, tertiary care, and sub-specialist work force expansions, at the very time when the basic health status and well-being of the country — the "infrastructure" not of concrete and steel, but of mind and tissue — has rotted away before our very eyes. We all know the drill: We spend twice as much on health care, but have half the quality, and a quarter of the well-being, of many other countries. Over a third of our population is obese, and most of the top ten causes of death and disease are related to killer lifestyles, the equivalent biologically of credit default swap derivatives.
The health care crisis is simply another man-made and unsustainable bubble.
Health plans have sold us risky and inflated paper, while the government has looked the other way, in effect leading us all to make bets on exotic and often counter-productive efforts to keep people alive at any cost. Private companies have in turn bet on the harvesting of disease via treatments that are expensive, risky, and often not even proven to be effective; or they have been allowed to skip past regulatory approval processes meant to assure safety. Read "Overtreated" by Shannon Brownlee if you have any doubt about the lack of value of much of the expenditures on medical research and care each year in the US.
In a manner that can only be described as awesome, the recent collapse of the financial system and the government’s response has proven there is nothing sacred about free market capitalism run by an army of greedy and windfall profiteering financiers. Neither is there anything sacrosanct or pre-ordained about a health care system that treats sickness as a source of profit and sick people as complex annuities that assure the wealth of health plan executives, procedural specialists, hospitals, and drug companies.
There is nothing, in short, written in stone that says we, the people, can’t decide to invest our health resources in primary care, in health promotion, and in wellness. It can and should be done. In fact, it makes no more sense to abide with a completely de-regulated health care system than it does to put up with a "free market" financial system. Both are bound to bring us to our knees sooner or later.
Will people see it this way? Will they act on this perspective? One thing is certain. We have seen the rules of the game change very quickly with respect to the financial industry. The reaction by the majority of the US population has been disbelief, anger, and fear, followed by new understanding of how we were all duped. Certainly, part of the anger is that of the drinker looking in the mirror the morning after with a bad hang-over: We’re all complicit and we must share in the blame. But the party’s over.
Let’s get on with the hard work of change that will be productive of reform our health care system. Our children’s health is too important to let ourselves fail.