Posted: 03/29/13 14:38
by Dave Mindeman
When I talk about health care, I generally deal with health care the way it is....not the way I would like it to be. Over the years we have locked ourselves into a juggernaut.
When Dwight Eisenhower left the Presidency, he warned us about the coming Military Industrial Complex. A system of defense that protected itself and developed a type of self-sustainment that transcended logic.
We have the same thing in Health Care....a Health Care Industrial Complex if you will. It has promoted itself as a "growth" industry when the reality is that it is a consuming parasite that cannot be controlled.
The numbers are daunting. Health Care consumes 15.3% of the national GDP. 11% of all employment is in health care. We spend $7,498 health care dollars annually on every man, woman and child in the US. Even during the recession (since 2007), healthcare jobs have increased by 559,000.
Of the Fortune 500 companies, 58 are health care related (over 10%). 12 involve Pharmaceuticals (Pfizer #40), 11 in Medical Insurance (United Health is #22), 8 are Medical facilities, 6 are in Pharmacy or other Health Care (Medco #36), 5 are Health Care Wholesalers (McKesson is #14), and 10 are Food and Drug Retailers (CVS is #18).
Healthcare is ingrained as an institution and efforts to reform or change it only happen on the margins. Health Care Industrial Complex is an economic leviathan.
Our efforts at reform bump into this monstrosity whenever we make the attempt. The Clinton administration looked like it might have had a chance back in the 1990's, but was beaten back by massive and intense lobbying. The Obama administration took the approach of working from within the sytem. The ACA was the result....but it really is just a hybrid of the same system with marginal reforms.
Single payer is the logical solution, but going up agains this type of industrial complex makes that type of radical change nearly impossible. Obama's ACA could have given us a true opening to real reform if the public option had been allowed to be in the mix. But the Health Care Industrial Complex (let's just call it the HCIC), sent in their big lobbying guns to squelch that possibility.
When the Republicans attack the ACA, they are largely attacking an entity that they had a large hand in formulating. They forced it to merge with existing industries. They forced slow implementation that has been inefficient and burdensome. And they have attacked the revenue streams that would keep it from adding to the deficit.
And we continue to depend on an employer based system with which we have this love-hate relationship. Employers find it burdensome but don't want to hand it off to the government either. It is grossly inefficient in costs, but they refuse to take the chance of any big changes outside of their control.
And the HCIC itself fights change at every turn. It is a big, ugly business with deep entrenchment.
Another annoying aspect is this Republican insistence that we need more competition in this system while at the same time they fight to protect the barriers to real competition.
The Health Insurace industry defines competition in health care as finding the best ways to NOT cover sick people; and to control the items and procedures they have to pay for.
That is not competition and it sure as hell isn't healthcare.
I can't give you a solution because the status quo is a powerful entity. But there would be one thing that Minnesota could do to at least point the way. We have the single payer, Minnesota Health Plan, sitting in the legislature waiting for action. I'm not sure, but I assume with a Federal waiver, Minnesota could enact this legislation and show the country a new way. A more logical way. A more cost effective way.
Of course, that means butting heads with the HCIC -- but shouldn't we at least try?