I've said that I support whatever changes ongoing Democratic Party efforts to craft a "health care reform" bill can produce. The Republican Party has mainly chosen to sit the effort out (will the upcoming open meeting with the President change that?) but even many GOP stalwarts agree that certain excesses of our current system, mainly shameful disparities in health insurance, need to be addressed.
I've also said - like many critics from both right and left - that what's on the table currently fails to address significantly the issue of costs. Even if a little smoke-and-mirrors and one or two hazy assumptions could deliver (say) coverage for everyone now uninsured, the question of the ever-rising price of health care for the rest of us remains undealt with.
Finally, I've said, as most reformers shy away from saying, that it seems to me the only answer in the long term is to completely revamp our existing unfettered for-profit system. My own assumption has been that we'd have to move toward a system similar to what most other developed countries now practice -- in which the government plays a role in setting, or limiting, prices. Yet that, too, is imperfect, since many of those other countries, though doing far better than we are, still face continuously rising costs.
There is another school of thought. Recently my attention was drawn to an essay by David Goldhill in last September's The Atlantic, entitled "How American Health Care Killed My Father." It's long, but worth a read. As the title suggests Goldhill focuses largely on the shocking shortcomings of our current system, which include not just high costs but a seeming indifference to basic changes that could save lives. Ultimately, he focuses on what's known as "consumer-driven" care -- the essence of which is to allow individuals to pay for more of their own care directly, rather than through insurance, so that they have a stake in controlling cost. It's not a new idea, but the author makes his case persuasively.
Goldhill, a businessman, confesses he is not a medical professional; he should also have noted that he's not a political scientist, either. The changes proposed by advocates of consumer-driven care (Regina Herzlinger, of Harvard Business, is identified here as one such) would be far-reaching, totally restructuring our health care system, threatening the profits of insurance companies, hospitals, drug companies, and the whole "health care industry" as well as their representatives in the halls of Congress.
The author admits a changeover would have to be gradual, and would take a generation to be accomplished fully (as younger people just entering the workforce begin saving for their future health care rather than paying into health insurance.) The approach makes a lot of sense but it's difficult to imagine, in our current hyperpartisan political climate, or even in a more mellow one, how the country could make this gigantic shift. Our current President has demonstrated a surprising willingness to push for radical but politically unpopular changes; our current Congress has shown an indomitable preference for petty party politics over the national interest.
Thus in the kingdom of the shortsighted, we'll still need a political catalyst -- the total failure of our health care system, in some way now unanticipated -- before even the most farsighted leadership will be able to push us down the path to changing what needs to be changed.
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