Real Health Care Reform

Published January 1, 2008

My career spanned 50 years of employment in different areas of health care. My wife, also a health care professional, and I have traveled all over the world, including trips that provided in-depth, on-site observation of health care systems in more than 30 countries. So we have real-life experience that allows us to compare our health care system with those in other countries.

We have found no nationalized health care system that serves all its citizens. Almost all have a separate health care system accessible by money or position.

While some Americans are enamored of other countries’ systems, it’s clear nationalized systems suffer from limited investment in technologies, and almost all have waiting times Americans would find unacceptable. While we can learn things from other countries, we are on our own when trying to reform our system.

Personal Responsibility

With this perspective, the growing U.S. health care debate bothers me. Incremental steps toward a nationalized system on one hand, and unwillingness to debate anything but a free-market system on the other, allow problems to fester.

And then there’s Michael Moore’s propaganda film, Sicko. While entertaining, Moore’s comments and actions outside the movie provide us with more insight than the film itself. Apparently, he’s sorry he is overweight; this indicates he understands that lifestyle is an important aspect of health care reform.

It also reveals what a 1980s Swedish public health researcher called “the diseases of wealth.” Collectively, we have come to believe that virtually every illness is curable. Consequently, we have lost the will to properly care for ourselves.

Evaluating our health care system by looking at longevity and infant death statistics confuses cause and effect. We know these statistics measure social and personal lifestyle issues, not the health care delivery system. Such statistics, when used to promote health care reform, are misguided and send reform discussions in the wrong direction.

Basic Issues

Meanwhile, counting the uninsured and complaining about costs gets us nowhere. This inadequate approach leads to more government insurance proposals, more price controls, and more government spending.

The first step in trying to solve any problem is defining it. This means identifying basic issues, not just symptoms. To get serious about health care reform, we must face these basic problems:

  • excessive dependence on the health care system for lifestyle problems and unreasonable patient expectations;
  • the unfortunate link between employment and health insurance, which limits employee flexibility and discourages personal responsibility;
  • tort system defects and defensive medicine, which raise health care costs at least 10 percent;
  • federal income tax unfairness that benefits only some citizens; and
  • state-level health insurance mandates that swell insurance costs and the number of uninsured.

The bottom line: Americans use, and demand, too much health care. In response, government and insurance companies ratchet down payments to providers, reducing supply. Our nation cannot afford this.

Stuart A. Wesbury, Jr. ([email protected]) is a professor emeritus at Arizona State University and former CEO of the American College of Healthcare Executives.