Health Systems and the Public Interest, Part II

You lie!

That’s the shout that rang out across the venerable chamber of the United States House of Representatives last week. It was hurled across the room by an angry politician at the President of the United States during a nationally televised speech at a joint session of Congress.

No such brazen heckling had ever occurred in the history of the republic. After being chastened by members of his own Republican Party about his grievous offense, the Congressman issued an immediate apology to President Obama. Nevertheless, commentators across the nation decried the coarsening of our social and political discourse.

But let’s consider the condition of our society for a moment. In retrospect, isn’t it a bit surprising that it actually took so long for this to happen? Politicians have been demonizing each other for many years, and have watched their supporters attend and disrupt the public events of their opponents. Sooner or later, it was inevitable that such incivility would seep into the hallowed halls of Congress.

So what has protected our federal government from such unruly outbursts until now? Most likely, it has been sheer institutional inertia that has protected our government from the coarsening effects that have plagued our society, inertia that is also impeding – and perhaps protecting as well – our health care system from the upheaval of massive reform.

Government Inertia

Last week’s Part I of this column concluded by noting our public consensus that the federal government should play some role, even if just a limited one, in ensuring health care access for all Americans. It explained that such a consensus places politicians squarely in the midst of all reform efforts, which proves to be both a blessing and a curse to innovators who are seeking to improve the system.

On the one hand, intense government involvement is a mighty force that applies the powers of legal regulation and budget spending to enact sweeping change. But on the other hand, such involvement is also a deadening force that buries the possibility of change under a blanket of feasibility studies, public feedback meetings, and arcane parliamentary activities.

Our government is indeed a massive bureaucracy that, like any huge organization, struggles to adapt to changing conditions across numerous sectors. Financial service industry reform initiatives, for instance, are now stalled despite the recent bank-induced economic collapse that almost plunged the world into a Second Great Depression. And although scientists agree that global warming will dramatically affect future climate conditions, a national plan that effectively addresses the challenge remains elusive.

National Health Care: How Did We Get Here?

Our entire national health system, of course, can be characterized as a haphazard collection of programs that were originally created under social conditions that are now obsolete. The programs, though, have never been modified to adapt to contemporary conditions because of government inertia.

Consider, for instance, the motley assortment of health programs that cover the majority of working adults in this nation; namely, plans offered by for-profit insurers. Why are employers involved with their employees’ personal health insurance policies at all, as opposed to their personal property or liability insurance policies? Well, they only began offering health insurance as a fringe benefit when the government temporarily placed price controls on wages, and simultaneously made business expenditures for employee health insurance contracts tax deductible.

Health benefits were then viewed as a simple avenue for modestly increasing employee compensation at a time when wage increases were prohibited. Today, of course, wage increases are commonplace … and yet the government regulated system of health insurance remains rooted in place.

A similar situation exists in Medicare, the federal program that insures all citizens over 65 years of age. It was originally created during the Johnson Administration’s War on Poverty to provide an affordable and relatively inexpensive array of medical services to seniors in the final few years of their lives.

Today, of course, it covers an overwhelming array of incredibly costly services. And many seniors now live well into their 80s, 90s, and even their centenarian years, relying on Medicare to finance their care for many decades. And yet the government system of insurance for such individuals remains rooted in its original form.

What Comes Next?

President Barack Obama entered public office with a promise to enact Change We Can Believe In. And citizens across the ideological spectrum agree that change is indeed required to address the various failings of our national health system. But can we actually believe that our government possesses the will and the ability to enact such change?

In today’s volatile social and political environment, it is undoubtedly a fool’s game to undertake predictions about any proposed legislative initiative. Nevertheless, considering the government’s longstanding condition of institutional inertia, it may be unrealistic to hope that truly universal coverage will become a reality in the near future.

Insurance reform? Yes, that is realistic … and in fact is likely. An expansion of new initiatives to serve the uninsured? That too is realistic … and would actually represent a continuation of trends that have promoted programs such as Medicaid and CHIP.

But government legislation that would provide every legal resident with universal health care? Though we can always hope for such an outcome, it may be unrealistic to expect one any time soon.