Laura Siminoff, Dean of the College of Public Health and Laura H. Carnell Professor of Public Health, says that as our nation rethinks its healthcare system, we must also reconsider what's at stake.
In all the controversy about the Affordable Care Act, a larger question remains: what if neither side is arguing for what we actually need? Repealing the ACA and eliminating its gains would push our country backwards. But supporters of healthcare reform often sidestep the fact that the ACA simply cannot fix our system. If we want healthcare that truly works—both for our citizens and for our economy—it’s time to consider other options.
The need for change is obvious: healthcare costs in the U.S. are higher than anywhere else in the world, but our system is one of the least efficient in providing quality care and good outcomes. That’s because our country treats healthcare as a profit-making product. It incentivizes high prices while de-emphasizing preventive care, which is almost always less expensive for consumers (and thus less profitable).
The consequences of this mindset are profound. Our primary care physicians don’t have the support they need to provide effective counseling for important health concerns such as obesity and smoking, even though these lead to long term health problems such as diabetes, heart disease and cancer. And because our government is unable to regulate drug prices (which are higher than anywhere else in the world), many people are forced to skimp on the medications they need to manage their health conditions, even when they have insurance plans. All of this leads to more reliance on emergency care—which is exponentially more expensive than simply making drugs affordable, managing chronic diseases properly, and providing better, more comprehensive maintenance of health in the first place.
There is a better way. The United Kingdom’s government provides high-quality care for everyone, regardless of income. In the Netherlands, private hospitals and insurance companies operate as non-profits, a system that ranks amongst the best in the world. These countries and others have proven that well-regulated non-profit healthcare systems provide far better care at far lower costs.
Would a model like this work in the United States? Yes—it already does. Medicare and Medicaid have demonstrated that government-funded healthcare can provide affordable, effective care and generate bi-partisan legislative support. These programs have transformed public health and the health of our oldest citizens over the past 50 years, and transformative change is what we need now. Maybe it’s time to seriously consider Medicare for everyone.
Good healthcare does not work as a profit-making enterprise, because healthcare is not a typical consumer good; our policymakers—and our public debate—should stop trying to make it so. There are successful alternatives within our own country and abroad. The day we start considering them as realistic options is the day we start building an equitable, sustainable path to better health for all.