Saturday, January 12, 2008

Can our government be trusted to run a universal healthcare system?

I've been involved in several discussions about the Analysis of the Candidates’ Healthcare Proposals web site I published last week (and have updated since then). Much of the debate centers on mandates and trust of our government to run a nation-wide universal healthcare system.

One reader had this to say:

Within the current system, the mandated "Medicare drug plan" appears to be heavily weighted to benefit the pharmaceutical manufacturing & distribution industry. Please give me your thoughts or analysis on the recognition of the candidates in what certainly appears to be an industry with very powerful influence in government. My personal assessment/feeling leans toward a more competitive market with as few government controls as possible. However I do feel government has a needed and viable role in the healthcare of our citizens.
I responded as follows:
I haven't analyzed who benefits most from the Medicare drug plan, but based on my understanding of our current healthcare system, I have little doubt that powerful lobbies influence policy. For example, a 2004 study on healthcare lobbyists [here’s the link] found that, of the of 1192 organizations were involved in healthcare lobbying, pharmaceutical companies spend more money lobbying Congress than other health care organization. Other top lobbyists are medical device manufacturers, insurance companies and healthcare provider organizations. In 2000, healthcare lobbying expenditures totaled $237 million, which was more than the lobbying expenditures of every other industry, including agriculture, communications and defense.

This supports your implication that our government can’t be trusted to do the right thing for the masses due to the influence of special interests.

At the same time, these data imply that these special interest groups--i.e., those making money from the current system--will not likely start delivering high-value to the consumer/patient on their own since greater cost-effectiveness for the consumer/patient eats into their profits under our current broken healthcare system (see this link for more about the need for a greater value).

So, I agree that more sensible competition is one part of the solution, and I agree there must be government mandates if we are to have quality improvement, cost control and good care for all. But it’s debatable as to the kind of government influence is needed (e.g., what types of mandates) and what can be done to hold politicians accountable to the people/consumers/citizens?

Personally, I’d like to see our government provide funding and management for all the reasonable quality improvement and cost control strategies presented in the candidate comparison web site. I’d like this to be done in the most effective and efficient way possible, with all government agencies involved being closely watched and scrutinized by an independent oversight organization whose allegiance is to the consumer.

One question is whether a single-payer system, which is run completely by the government as in other countries, would be better than a system in which private insurers compete with a government run universal healthcare program. As discussed in the candidate comparison web site, the main arguments against a single-payer system can be disputed. CMS does run Medicare and Medicaid after all, which is a single-payer system.
The issue of trust in our government, however, remains unresolved. I suggest that these be the healthcare-related issue we focus on.

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