President Obama and the 535 members of Congress seem to have at least 600 different national medical insurance proposals, some of our leaders being of two or more minds on the subject. Analysts writing in the press push additional panaceas and utter platitudes in abundance. Mixed in with all this is propaganda from insurance companies' spin-doctors and from other corporations with major interests at stake.
Policy affecting one sixth of our gross domestic production should not be created by such a haphazard approach.
Agreement on major legislation does not seem likely in the near future. But it should be possible for Republican and Democratic leaders to create a process which could produce legislation most Americans could agree on during the second half of President Obama’s first term.
Congress should establish a bipartisan commission on National Medical Policy. Although the commission would hear testimony from representatives of the medical and health care professions and the drug and insurance companies, none of the commissioners should be representatives of these self-interested parties.
The main job of the commission would be to study all of the major countries that have national health insurance programs. It would analyze the respective advantages and disadvantages of these various national systems.
The commission would then be charged with drafting a proposal---appropriate to American circumstances--- that would to the greatest possible degree incorporate the strengths of these other systems while avoiding their weaknesses. Hopefully, a proposal would emerge from the commission that could command bipartisan support in Congress.
Our expectations for the commission should not be too high. Any possible medical system will have some defects, given the many conflicting interests and considerations. Services covered must be limited to some extent since medical technologies now exist that are too expensive to provide them to everyone who might benefit.
If the new system is a single-payer one, it will be necessary to raise taxes in order to pay for it. But this would be offset for the average person by elimination of the medical insurance premiums that we now pay, directly or indirectly in the form of reduced wages when our employer writes the check for the insurance. If the system is not a single-payer one, it will force people to make complex choices that may be beyond most of us, and may include mandatory purchase of private insurance that would be a tax in everything but name.
The commissioners must be willing to follow the evidence wherever it leads. If it leads, as I expect, to a single-payer system, the fact that this might put the private insurance companies out of business (they could still sell other kinds of insurance) should not be a deal-breaker. Life is tough. A country which has survived the bankruptcy of airlines, auto companies, and banks should not hesitate to put the insurance companies out of their misery if it is what the public welfare requires. Jobs would be lost at the insurance companies, but new jobs would be created administering the new system.
Over two thousand years ago, Aristotle compared the constitutions of the various Greek city states in his effort to determine an ideal form of government. It would likewise be intelligent for Americans to study the experience of others before coming to any conclusions about major medical reforms.