1.20.2010

To those who fear that Universal Healthcare is Dead

The following is based on a thread initiated by my friend Birgit, and helped along by my friend Steve. On the issue of Federally funded healthcare I believe we differ. On the issue of quality healthcare delivered effectively and efficiently to the largest population possible - I think we are in complete agreement.

Rather than punt to the Federal government the local issue of health care delivery, why don't we let the citizens of California (Pop 37M), Texas (Pop 24M), NY (Pop 19.5M) , Florida (Pop 18M), Illinois (Pop 12.9) Pennsylvania (Pop 12.4M), etcetera. chose (or not) their own program as has Massachusetts (Pop 6.5M)? For states w/ populations below say 5m, create intra-state medical regions that will operate as do the larger states?

I contend that to compare the United States (303M) to Germany (83M), Switzerland (7.6M), the Netherlands (17M), Australia (21.2M), or Canada (33M) is to miss the importance of scale and jurisdiction. While Uwe Rhinehardt's perspective with respect to community risk and risk equalization describes a standard actuarial model for healthcare funding, it fails to acknowledge the differences in scale between the examples and the United States, and ignores the unique regional implications of the nature of Unites States and the separation of powers between the Federal and State Governments.

Whether you like the plan or not, I think Massachusetts has proven a plan can be enacted and administered at the State level. That said - one should evaluate its current
performance and ask if this is what is wanted for the other states, let alone the nation.


Do we want basic healthcare for all, or a federally mandated and controlled program? In my opinion, one does not imply the other.

For an example of privately managed and quality healthcare, *Kaiser Permanente was born in 1930. Dr. Sydney Garfield seized an opportunity that simplified his back office (billing) and provided full healthcare to thousands of workers on the LA Aqueduct. He wasn't trying to get rich - just deliver high quality healthcare in the most efficient (business and medical) means possible. *Full Disclosure - I was an employee of Kaiser Permanente from 1991-1999

My friends who advocate a universal plan do so from the best of motives. They ask why should we who have "good" jobs be able to afford good health care that preserves our lifestyle - when those who "are not lucky enough" suffer loss of jobs, savings, and homes when struck with debilitating illness or injury? Another post will be required to do justice to this question.

I don't believe quality healthcare can be born out of pure profit motive (capitalist though I be) nor from government coercion. I believe it can only be forged by like minded individuals, organizations, and health care providers, banding together to articulate a shared objective and selling it to the populace that are to be its beneficiaries.

When the healthcare reform debate becomes more about the definition of basic quality care, its effective delivery, and efficient financial structures, we will start to perceive what reform means. As long as the discussion centers on secondary issues (or agendas) - or is politicized (meaning its character is shaped by current political powers) we will be a long way from any healthcare reform - universal or otherwise.

Respectfully yours,

~r

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