How We Got To This Peculiar Place

American health policy has reached a peculiar place – no “solution” is acceptable to all stakeholders, yet status quo earns the crisis title year after year.  How did we get here?  For a clear, concise recounting of the epic journey, try Paul Starr’s Remedy and Reaction.

Starr traces the history from the 1900’s, through the creation of Medicare and Medicaid in the 1960’s, and up to 2010’s Affordable Care Act.

People protesting health reform

People demonstrated for and against our latest health reform.

Some of my favorite quotes:

“While there was a negative consensus that something was wrong with the health-care system, there was no positive consensus about how to fix it.”

(Here he is describing the early 1990’s, but it could just as well describe today.  I frankly doubt that any effective way forward would satisfy all stakeholders.  The idea that everyone will be happy with a solution is unrealistic; some sector is going to be at the very least, unhappy and at the most, bloodied.)

“Instead of serving as a foundation for national health insurance, Medicare functioned more like a prophylactic against it.”

(The lack of cost controls meant that it could be painted as just another government-program-gone-wild.  It’s interesting to me that Medicare is considered as American as apple pie for everyone age 65 and up; for anyone 64 and younger, government health programs are a subversive form of socialism.)

“Rather than settling the long conflict over health insurance, the Affordable Care Act launched the conflict into a new phase.”

(The single-party support for the bill was only the beginning of its tortured path.  Opponents continue to skewer it, even though as Starr points out, the core ideas – including the individual mandate — came from moderate Republicans in the early 1990s.) 

Granted, Starr was one of the key players in Clinton’s failed health reform plans.  His view of the players, agendas, and politics is through the liberal lens.  The liberal’s history is a litany of failed attempts to reach universal coverage, if not single payer.  You can feel Starr’s attitude: one of the segments of the book is titled, “Evolution Through Defeat.”

Nonetheless, even a conservative would have to agree that efforts to improve health care access and efficiency have failed.  It would be disingenuous to describe all of the health policy legislation and campaigns as attacks on liberty.  To do so would imply that our current status quo is the best result of democracy.

A person could read Starr’s book and become more cynical about the U.S. ever landing on a reasonable, equitable, acceptable health system.  Indeed, on many days, I’m doubtful that any progress will be made.  Yet, we can only do what we can today and tomorrow and the next day to apply our best talents.  What will outlast us all is hope.

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