Monday, March 19, 2012
A Federal-State Framework for Market-Based Reform
I’ve contributed the final chapter to the new book The Great Experiment: The States, the Feds, and Your Healthcare, available on Amazon and published by the Pioneer Institute. Here’s an excerpt:
Despite criticism from some quarters, the health care system in the United States has significant strengths. The hospitals and clinics through which most Americans get their care are staffed by some of the world's most highly trained and accomplished physicians and these institutions have the capacity to deliver the finest and most sophisticated medical care found anywhere in the world. Most Americans have ready access to this care through third-party insurance arrangements provided by their employers, or in the case of seniors, by Medicare. Finally, U.S. health care is open to medical innovation in ways that other systems around the world are not. The resulting rapid pace of innovation that has occurred in recent decades has, in the main, provided a tremendous boost to the quality of patient care.
There are also many problems with American health care. These problems are aggravated by the Patient Protection and Affordable Care Act (PPACA) but they will remain even if the PPACA is repealed. These problems have worsened in the past three decades, to the point where a large percentage of the electorate believes real change is needed.
These problems include:
- Cost increases that exceed the levels that patients, taxpayers, or other payers are either able or willing to pay
- Government spending on health care that is rising much more rapidly than the revenue base that pays for it, thus putting tremendous strain not just on governmental finances but also on U.S. economy and credit-worthiness
- A substantial number of Americans with pre-existing conditions who either cannot afford or cannot find insurance options that provide secure and sufficient coverage for their conditions
- A considerable number of working Americans who go without insurance for long periods or intermittently because they cannot afford it or it is not offered by their employers
- A surprisingly low and unpredictable quality of care in many settings
What the American health care sector needs most is the discipline, balance, and accountability that come from a functioning marketplace....