by Atul Gawande
New Yorker, October 2, 2017
This is a timely and informative essay.
Gawande meets with some old friends in Athens, Ohio, where he grew up, to discuss their take on the question. It is kind of a trip down memory lane for him.
The meat of the essay comes about halfway through when he discusses the work of the Oxford political philosopher Henry Shue who postulates that basic rights include physical security, water, shelter, and health care. Meeting these basics is among governments highest purposes and priorities.
I think the goal should be security. No matter how bad things get this shouldn't be what you worry about, namely healthcare.
When people in a society get very different deals on things like healthcare, the pact with the government breaks down. That's what is happened with American healthcare.
The reasons go back to a seemingly innocuous decision made during the Second World War. In that time, the administration permitted increases in health insurance benefits and made them tax-deductible for employers. It didn't seem like a big thing at the time, but ever since we've been trying to figure out how to cover the vast portion of the country that doesn't have employer-based health insurance. Therefore, we had to stitch together different rules and systems for each of these categories and the result is an unholy expensive mess that leaves millions of people un- or under-protected. As a country, where pretty much everyone gets options like K – 12 schooling we've been reluctant to address the Second World War mistake and establish a basic system of healthcare coverage that's open for all. The prospects and costs of healthcare in America very wildly and incomprehensibly according to your job, your state, your age, your income, your marital status, your gender, and your medical history, not to mention your ability to read fine print.
Do we want?
- Medicare for all
- Each state to have its own plan for care
- A nationwide market place where we all choose among a selection of health plans
- Or personal accounts that we can use to pay directly for healthcare?
Any of these could work. Each has been made to work universally somewhere in the world.
As a country, we don't have any of these at this time. Gawande's article is a lucid introduction to this area, and worth reading and studying for healthcare providers, the public, and all students.