A health care riddle, and the solution!

By Richard Kirsch

Here's a riddle. It's a two-parter.

How is it that the United States spends much more on health care than any other country in the world but still leaves 46 million Americans uninsured? And how is it all other developed countries provide health coverage to every citizen and still spend so much less? The answer's in the riddle. Other countries spend less because they provide coverage to everyone.

The budget hawks in Congress would be wise to remember this riddle when they listen to President Obama give his budget address before a joint session of Congress next week. We expect the President will call for a major investment in health care, including guaranteeing affordable coverage for every American. He is almost certain to repeat, as he has done numerous times before and after the election, that we cannot solve our long-term economic problems unless we fix our health care system too.

President Obama's budget release will be the first formal step in the legislative dance that the President hopes will result in the passage of health care reform - including quality, affordable coverage for all - by the end of 2009. While opponents of reform will use every argument in their arsenal, one of the biggest obstacles will be Congressional reluctance to make any upfront investment that would add to the federal budget deficit in the short term.

However, leading economists and policy experts agree that the only way to bring health care costs under control is to make big, comprehensive changes. We need to shift the focus of our health care system from maximizing revenue for health care providers and insurers to maximizing the health status of Americans.

There are a host of reasons we spend so much more on health care than other developed nations while lagging woefully behind on quality of care. The tens of millions without coverage and the tens of millions with inadequate coverage - including high out-of-pocket costs - don't get preventive care and delay treatment at the first signs of illness. They then end up in the system later when they're much sicker, and treating them is more expensive. Our private health insurers spend huge sums of money trying to avoid covering people who are sick (and costly) and trying to get out of paying claims. This translates into high administrative costs for insurers, doctors, and hospitals while individuals are hounded by bill collectors.

Drug companies and medical-device manufacturers push doctors into prescribing expensive new drugs and using the latest pieces of equipment without any evidence that these new treatments are better or more effective. Doctors have financial incentives to prescribe more care even if it's not necessarily better care. And hospitals are driven to offer more lucrative services than necessary services in any given community.

For each of these cost drivers, there is a major special interest that is making major money off our health care system. You better believe they will do everything in their power to resist change. As President Obama said on the campaign trail, "[W]e are tired of watching as year after year, candidates offer up detailed health care plans with great fanfare and promise, only to see them crushed under the weight of Washington politics and drug and insurance lobbying once the campaign is over."

The fact remains though, as the President said again last week, "[T]here are some people who are making the argument that, well, you can't do anything about health care because the economy comes first. They don't understand that health care is the biggest component of our economy and, when it's broken, that affects everything." Too many of these naysayers are members of Congress who see only short term deficit figures and fail to grasp the unparalleled long-term impact comprehensive health care reform will have on our economy and the federal budget.

The sooner we act the better. As long as health care costs far outstrip inflation and other economic growth, the health care system will eat up a bigger and bigger share of the nation's income, continuing to place huge financial stress on our families, our businesses, and our government.

The President and Congress already took some steps toward controlling costs in the Economic Recovery Act, including investing in electronic medical records and investing in research to find out which treatments work best compared to others.

But there's a whole lot more to be done, and it's not hard to figure out what that is. We need to cover everyone with benefits that meet health care needs from prevention through chronic care. We need to remove financial barriers that stop people from getting care early. And we must provide people the choice of a public health insurance plan as an alternative to private health insurance, especially since there is a large and growing body of evidence demonstrating that public health insurance plans do a much better job of controlling costs than private insurance. Each of these proposals is included in President Obama's health care plan.

The hardest part of health care reform is actually going to be countering the fear-mongering about change. The interests that profit off our current system are already starting to fight. So are frenzied ideologues who think government involvement in health reform is a bad thing. We need to remind them that our government exists to work for the people it represents, and letting private insurers continue to run amok and milk the system without rules or oversight is just plain foolish.

At the end of the day the fact remains that if we are to have a healthy economy, we need to provide good, affordable health care coverage to everyone in a system based on promoting health not maximizing profit. Solving that political riddle in 2009 will be one of President Obama's greatest political challenges and triumphs.

Richard Kirsch is National Campaign Manager for Health Care for America Now, a national coalition of labor, community groups and progressive organizations dedicated to reforming the nation's health care system. This opinion piece appeared originally in The Huffington Post.