If Congress wanted to establish the health care system we have in America today, it would never pass. In fact, it wouldn’t even come close to passing. Why? Although we are accustomed to the complexity of today’s system, it looks absurd on paper. It is also absurd in practice when you try to navigate it as a patient, provider or premium payer.
As a noted Nashville physician says, we don’t have a health care system in our country — we’ve got a “sickness-care non-system.” This non-system produces some of the best medical technology and best care on earth (if you can afford it), but it makes prevention and wellness a low priority. It’s breaking family and national budgets. Already this year, average health insurance premiums have increased 15 percent, putting coverage out of reach for more small businesses and families. Not even the richest nation on earth can afford this price spiral.
The non-system is so confusing that doctors have been hiring nurses, not to help treat patients, but to handle paperwork from private insurance companies. These 1,800 companies have competed, not to help people stay healthy and get well soon, but to get rid of anyone who might actually need medical care. They don’t want to insure all Tennesseans, dividing us instead into the smallest possible groups so that it’s easier for them to raise rates. All it takes is one illness or injury to one small-business employee for premiums to go through the roof.
The negative form of competition is so familiar that many people have given up imagining a better system: one where everyone could qualify for private-sector coverage, pay fair rates and have the security of knowing that they could keep that coverage regardless of where they live or work. This is not a fantasy. Federal employees have benefited from that kind of positive competition for several decades; it’s high time that we shared that way of shopping for health benefits with the public. It’s a lot easier to raise a healthy family with that kind of insurance, and that kind of confidence.
Most of today’s non-system is the result of a World War II fluke. Congress never voted on it, and never intended it. Instead, it grew like kudzu from seeds that were planted by companies whose goal was not to keep people healthy, but to fill hospitals and doctors’ offices with patients. It grew faster when an IRS clerk in the 1950s decided that fringe benefits should be treated better than cash pay, skewing our entire medical industry toward unsustainable growth rates that have been crowding out other national needs. If current trends continue, it will take all of federal revenues just to treat our own bodies. There will be no money left over for such priorities as national defense or education.
Despite the absurdity of much of today’s non-system, it is hard to change.
The primary reason is that the $2.6 trillion that we spend on medical care precisely equals $2.6 trillion in incomes for people who are profiting from today’s non-system. This tempts them to ignore the evidence that we are probably wasting as much as $700 billion a year in spending that does little or nothing for our health — and sometimes even harms us.
What are some examples? Tennesseans tend to be overmedicated, with a recent average of 17.2 prescriptions per person, per year. No doctor can confidently predict the drug interactions if you are filling your stomach with too many pills, even if they are safe
individually; sometimes they combine to form a witch’s brew.
We also take more Oxycontin, a very powerful narcotic, than anyone else. Taking all these drugs might make sense if we were healthier, or more pain-free, as a result. But the evidence indicates that we aren’t benefiting. In fact, we’re risking bankruptcy in order to poison ourselves.
Keeping today’s sickness care non-system is not a viable option. It not only needs to be changed, it is collapsing on its own weight. Congress is having some difficulty agreeing on the most necessary improvements, but that debate is necessary. There are ways to reform the non-system that we can agree on that will make all Americans, and America itself, healthier and stronger.
Congressman Jim Cooper
represents Tennessee’s Fifth District.