In 1787 Thomas Jefferson wrote, "Without health there is no happiness. Attention to health, then, should take the place every other object." Certainly health, as an alternative to disease, is the goal of all enlightened individuals. It should be first and foremost in the minds of policy makers, both private and public. But what should be done, now that Clinton's National Healthcare System reform is dead?
The first President to run on a platform that included universal access to health care was Theodore Roosevelt in 1912. Thus if you take 1912 as a starting point, we've been in the business of trying to improve our health care system for 83 years to be exact. Where do we go from here? I suggest reconstruction.
The 103rd Congress failed to do anything at all about making the first step in health care improvement, which has to be free and unrestricted access to all. In fact, the Senate Finance Committee failed to present a single bill that included universal coverage in the past session of Congress. If a Democratic Congress cannot produce any meaningful legislation that aims to improve health care, will the Republicans do any better? They certainly have the mandate of the people, the mood for change, the talent, and the momentum. The 104th Congress should be guided by the fact that today Americans consider improved health care and access to all as a top priority on the National agenda.
My own view is that we should get rid of the word reform, since it implies that there is something inherently and fundamentally bad about our health care system. Since 85% of Americans are satisfied with the health care coverage that they have, and 93% like their doctors, what can be fundamentally wrong? The most immediate need is unrestricted access to care.
"Health Reconstruction" could be done on a statewide basis. For example, Hawaii has nearly achieved the ideal on its own already. Ninety-six percent of the population of Hawaii is insured. And the Hawaiians were able to do it at approximately $400 less than the average cost in the other 49 states, yet everything else in Hawaii is pretty expensive. A system that works in Hawaii may not work in New York, California, or even Colorado.
We could reconstruct health care on a state-by-state basis, if we were willing to drastically reduce cost through eliminating unnecessary bureaucracy and its duplication and develop cooperation between the private and public sectors. The giant entrepreneurial HMOs would have to do their bit, and everyone would have to give away some free care unless and until we can find a method of providing coverage for all. It wouldn't hurt any hospital, clinic, physician, or other health care provider to return to the principle of benevolence, which has been the underpinning of all of medicine since it began.
I'll be in touch next month.
Thomas Petty, MD