Thursday, August 20, 2009

Healthcare--Some Ideas

by Richard Crews

The U.S. healthcare system is a vast and complicated patchwork of ideas and principles; of individual careers and social patterns; of clinics, hospitals, pharmacies, educational programs, service and philanthropic groups--of schemes and dreams--that has grown up over many decades. It is expansive and expensive--it involves nearly one-sixth of the national economy. It is painfully personal and epically tragic--it interacts with our deepest emotional aches and existential fears.

And it is not particularly efficient nor effective. Several First-World countries provide their citizens better healthcare--by every measure from longevity and chronic disease statistics to waiting-room annoyances--than the U.S. does, and with less cost and social discontent.

Some say the U.S. healthcare system is in need of reform because of this fragmentation, socio-cultural dissonance, and disparity with other First-World systems. Alternatively, some say we need to fix it because science and medicine are progressing so fast that--like Lewis Carrol's famous metaphor--we have to run as hard as we can just to stay in the same place. But all knowledgeable analysts agree that healthcare costs are increasing, over a period of years and decades, faster than inflation and the growth of the U.S. economy (of GDP); in other words, if we do nothing but sit back and watch, healthcare costs will bankrupt our country--and hence our civilization and our way of life--over the next couple of decades.

That being said, we can set aside the political dilemma that has paralyzed healthcare reform up to now. Yes, there are entrenched interests--resistances from big business, from religion, from social and political powers. Yes, there is tremendous inertia--the healthcare system has been pieced together from bits and pieces that worked and didn't work over many decades. Yes, there is a disparity of views--for every good idea about what should be done, there are strong, reasonable counter-views as to why that particular idea should not be implemented. But we can set all this aside in our considerations, not because it is easy to overcome, but because--given the economic and historic handwriting on the wall--it MUST be overcome.

So here are some ideas--some of them "good ideas"--about what can, and must, be done in overhauling the U.S. healthcare system. (I plan to expand, with specifics, each of these broad "idea" areas.)

(1) Waste, inefficiencies, and economic inequities must be weeded out of the system.

(2) Greed and absurd proprietary profits must yield to proper competition and regulation.

(3) A strong thrust of education, disease prevention, and personal responsibility for health must be built into our lifestyle patterns.

(4) And perhaps most difficult and subtle, yet most important--religious views and idealized human rights notwithstanding--a shift to a sort of cultural realism regarding healing, maturation, aging, and death must find its way into and throughout our national self-image and cultural expectations.