“I want your Ugly. I want your Disease
I want your Everything, as long as it’s Free.”
—America’s leading contemporary philosopher, Stefani Germanotta (aka Lady Gaga)
Insight comes from unlikely sources. Lady Gaga nailed the health reform dilemma. We have a healthcare delivery system that is an orgy of profligacy and excess that offers the false promise of making ugliness, disease and death all optional. And, we the public love all of it, as long as it’s free, at least to us as individuals. We want high tech, high quality, high expectations met, highly trained professionals delivering high standards, paid by someone else. And the magic fairy that will pay for all of this? Health insurance. Give everyone an insurance card and they can have their everything and it will be free, or close to it.
But wait, isn’t the cost of insurance tied to the costs of care? Doesn’t the sum of all healthcare costs for a covered population (plus administrative costs) divided by the number of people equal the premium. Doesn’t the premium come out of my pocket as taxpayer, employee or individual? How can I have everything, as long as it’s free?
Short answer is: you can’t.
We are caught in a Bad Romance with healthcare.
The brutal truth is that the average American household cannot afford the average costs of care. With household income stagnant to declining at $50,000 a year and typical total healthcare costs at $15,000 per household, average people cannot afford the average costs of care. Even if we were to fully accept the notion that rich people have to subsidize poor people (which still seems a bit of a stretch to some on the right) you would think that in a wealthy county like America, the average household could afford the average cost of care. But as the healthcare debate showed both in Massachusetts and at the national level, nearly all of us need a subsidy to make health insurance affordable. (Say what?)
How can “affordable care” mean we need to subsidize nearly everyone?
Well, that’s a problem. There are really not enough rich people to go and tax. And those rich people are not having a good year. The revolting people of Massachusetts were independent voters who are paying their taxes and mortgages and mandatory health insurance premiums and who when asked to step up and pay taxes for a healthcare bill that wouldn’t help them any, said no to big government. (By the way, they also said yes to a telegenic, former nude centerfold who outhustled the dullest politician in America by a factor of 10 to 1). And they baulked at being asked to pay federal taxes to subsidize the mean-spirited people of Texas and Alabama who really don’t want to be forced by the federal government to cover poor people through Medicaid expansion or insurance exchanges or worse yet a public option.
Health reform may be dead. Sensible centrists like my friend and fellow futurist Jeff Goldsmith, the always sane and insightful Bob Laszewski, and my physician policy wonk pal Bob Wachter have all written eloquently on this blog about the possible political path forward. I will not repeat their points with which I nearly always violently agree.
Nor do I particularly want to unleash a flurry of rehashed mini-essays from all of you regular contributors about how health refom should or shouldn’t go from here. I know that each of you believe that your idea is the right one. I get that. And I am in reverential awe of the time you pour into these pages.
We should all be very grateful to Matthew Holt for creating this blog. His vision has created a meeting place for all of you out there who care deeply about healthcare and about politics and policy of healthcare. (I should say by way of full disclosure that I had the pleasure of working with Matthew for many years, hired him from Stanford to join the Institute for the Future, and played some modest mentoring role in his professional development. Matthew was also the inspiration of IFTF’s then dress code: “no shirt, no shoes, no salary”.)
So my plea to all you healthcare bloggers of America is this: Please turn your attention to the central problem. How can American healthcare delivery be better, faster, and cheaper in the future not more expensive and worse. And please no ideas about giving people insurance cards subsidized by someone else (especially not the Chinese or my children) as in the current proposals.
This community must have some good ideas about how to get us out of this mess. We are caught in a Bad Romance.
Ian Morrison is an author, consultant and futurist based in Menlo Park, Calif. He was indeed Matthew Holt’s boss at IFTF until Matthew quit the restrictive dress code and exchanged it for the blogger’s PJs.