Thursday, June 4, 2009

What Would A 'Perfectly-Functioning' Health Care System Look Like Anyway?

In over 22 years in and out of public service in Washington, DC and working on all sorts of committee staffs and entitlement commissions, here is one thing that no one, and I mean no single human being, was ever able to show to me for discussion and review:

'What would a perfectly-functioning private market-based health care system actually look like in America if we could create one from scratch?'

That may sound like an odd request and most people would look at me like I had a single eye socket in my forehead after I said it. But the idea was to find some model, some combination of operational and financial structure by which people could look at the end product and say: "So that is what a healthcare system would look like in a perfect world!"

Instead of the amalgamated, convoluted, legislatively-distorted, confusing mess of a system we have in place today which is about to be swept aside under the guise of 'health care reform' this summer.

After all, you can never get to your goal if you don't know where it is or even what it looks like, now can you? Has any inventor, entrepreneur, business executive, athlete, student or missionary ever succeeded without knowing what their goal of success would look like when they finally saw it, even after years of trial, error and heartbreak?

Here's the real problem when you ask this question in the political world: Everyone will give you their version of what a perfect health care system would look like with their priorities highlighted vis-a-vis every other interest. Physicians groups present plans that cut other areas but double or triple their Medicare reimbursement rates, for example. The hospitals do the same thing and so on down the line.

Hey! They are just doing their job and we have to respect that.

But who is looking out for the general good, the overall best interests of the nation at large instead of solely representing the varied special self-interests such as the labor unions, the insurance companies or the hospital groups?

Health care reform seems to me to be remarkably similar to the proceedings of the Constitutional Convention of 1787, believe it or not. Don't laugh at the comparison between the 111th Congress of today and the conclave of the "Founding Fathers" then. There were smart, dumb, humble, proud, drunk and sober delegates in attendance then just like today.

Delegates were sent to Philadelphia to hammer out the details of an entirely new form of government, hopefully better than what existed under the Articles of Confederation that preceded it. Just like what we want out of health care reform in 2009: a better, more comprehensive, less expensive health care system.

Is that too much to ask? Probably, unless major fundamental changes are enacted.

Every state in 1787 had their own self-serving 'special interest' to protect, be it the self-preservation of the small states such as Rhode Island and Delaware, the export business of the New England states or the plantation economy based on the "peculiar institution" of slavery, as it was euphemistically known then, in South Carolina, Georgia and North Carolina.

Fortunately, for them, for us and generations to follow, General George Washington and Benjamin Franklin were seated in attendance for every session of the Convention. They were able to persuade the delegates by their mere presence and stature to sacrifice marginal interests for the public good. (Washington was 6'2" at the time when most mere mortal American men stood only an average of 5'7" in height... a veritable Shaquille O'Neal tower of strength)

Can that be duplicated in these days and times? Who is going to stand there in Washington and command that sort of dispassionate objectivity to get the best health care reform outcome on a bipartisan basis as possible? President Obama? Speaker Pelosi? John Boehner? Rush Limbaugh?

Anyway, over the next several weeks of postings here at Telemachus, we are going to try to paint a canvas of what we think a 'perfectly operating health care system based on private market principles' would look like before it is wiped off the face of the American market map if this summer's health care reform effort goes askew.

The exercise is going to require a sense of detachment from the present time and a suspension of adherence to generally-accepted norms so be forewarned. However, we think we can realistically present a fully-functioning health care system that covers everyone in the nation with the same amount of money that is currently being spent on health care from all sources in this country today. Perhaps even less, if certain over-arching principles about using the private health insurance system are used or kept in place.

In the meantime, it would be nice if the Spectre of George Washington would rise up from his vault at Mount Vernon and seat itself at the head of both the US Senate and House for the next couple of months while Congress tackles health care reform just as his physical self did in Philadelphia over 200 years ago.

And while the Ghost of Washington is at it, maybe it will go visit President Obama late one night in the White House and urge him to follow his selfless example of leadership.

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