Providing and paying for health care ought to be a local and personal issue, not one in which the federal government plays a central role. It is the idea that the federal government had to solve health care crises that got us into this mess.
That, however, is not the thrust of this message. Rather, it has to do with the questions surrounding health care. Should our focus be to:
- Reduce overall health care spending? And if so, is that in real dollars, or a percentage of GDP, or both?
- Or is this about reducing per capita health care spending in wealthy states, while increasing it in less wealthy states? Or cities? Or neighborhoods?
- Increase access to all health care services for everyone? Or about reducing services for some, so that others can have what they now lack?
- Reduce the rate of those without health insurance to zero? Or those without someone else paying for their health care to zero?
Whichever question moves to the top of the list will leave the others unresolved. For instance, if our overall goal is to reduce health care spending, while maintaining access for everyone to quality health services on an equal basis (sounds like single-payer to me), then we will not accomplish any of those goals.
If we squeeze provider reimbursements believing it will reduce spending, it will also reduce the supply of providers. Many will quit.
If we open the floodgates so that everyone can have everything, it will send health care spending through the roof.
Try taking services away from Hollywood, California and give them to Hayward, Wisconsin.
I believe that the best way to get a handle on this is not to look to Washington, D.C., but look to Washington Street, Lane, Avenue, Blvd., Way, Court, or on any other street where health consumers live. Put them in charge of their own lives. They are up to it.
The president has far more important issues to tackle than where I get my next blood test, who pays for it.
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