The system has been lurching toward ruin for years and may get worse before reforms can take hold.
"It will happen by the end of the decade," predicts political economist Uwe Reinhardt of Princeton University. "But first we will really have some dark days. Our system is like a sick man who knows he is sick but doesn't want to go to the doctor because he fears what he might find out."
Reinhardt, who often has been consulted on the economics of health care by administrations and congressional leaders alike, says everyone agrees that the system is failing, yet "almost nobody wants to sit down and figure out what we need to do."
A report issued by the conservative Heritage Foundation cautions against the temptation to add new programs to a system described as "inherently unsound."
"Because of its fundamental flaws, the gaps in the existing health care system can never be closed at acceptable cost without structural changes," wrote Heritage's Stuart Butler and Edmund F. Haislmaier."
Among the more obvious flaws:
- Too many people are excluded from the system, and the costs simply are pricing others out of the market.
By most estimates, roughly 37 million people are without health insurance. In that group are some 22 million working poor and 15 million who are unemployed. Still others, perhaps as many as 15 million, are said to be underinsured.
Oklahoma's uninsured number from 600,000 to 800,000 employed workers. Despite a growing consensus that change is both essential and inevitable, a clash of ideas is a virtual certainty when experts and elected leaders start talking about the methods of financing needed care.
This year the nation's total health care bill will exceed $600 billion - approximately 12 percent of gross national product - with costs rising at an annual rate of 7 percent.
As the national government ponders its endless gusher of red ink, the allure of mandated care, thereby forcing employers and their employees to shoulder the entire financial burden of health care, has won over a small but vocal band in Congress. Sen. Edward M. Kennedy, D-Mass., has introduced legislation calling for mandated care, guaranteeing basic health coverage for everyone. But his bill is not expected to reach the floor this year.
Earlier in the year, the Bipartisan Commission on Comprehensive Health Care, also known as the Pepper Commission in honor of the late Rep. Claude Pepper, D-Fla., though divided chiefly along party lines, recommended an $86 billion per year national health insurance plan which also would include long-term care.
Underscoring the difficulty of finding agreement on financing mechanisms, the commission, headed by Sen. Jay Rockefeller, D-W. Va., was unable to advance any method to pay for such a plan. The report now gathers dust in the archives.
The ultimate irony is that so many people in and out of government know the sick and failing components of the health care delivery system. Perhaps no one alone has all the answers, but together they have the expertise to make the system work, even if that entails a remodeling of the structure. …