Watch, listen, or read any news source and you’ll come across opinion and news about the healthcare debate. It’s not too surprising – after all health care is about 17.3 % of our Gross Domestic Product (GDP). It’s also approximately a quarter of the federal budget. Beyond the impressive finances – this is our health we’re speaking of.
With the complexity of our lives it’s easiest to make a gut judgment about what to think of the healthcare proposal based on two questions: 1) do I trust the source and 2) what effect will this proposal have on me and my family. We’re all busy, but we must do better. Consider the following:
1. Who takes the financial risk?
Since not everyone has the same healthcare needs and we can’t predict the future, so there is considerable financial risk for individuals. Once a situation arises, not everyone knows what the medical costs will be. A pregnancy, for example could cost $5,000 or over $1 million in the baby’s first year for complications. Consider in any proposal - who takes this risk – the individual, taxpayers, citizens, the employer, doctors? How large is the risk pool and how is it shared and who decides? When does the risk fall to the individual or collective?
2. Is the focus on limiting expenses or improving quality of life?
The World Health Organization in 1948 stated that “health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” However, many proposals start from a cost perspective – how can we reduce costs or keep premiums low. This approach often pits different types of cuts against each other: large and sweeping vs. small and targeted but with the same goal: control costs. A less common approach focuses on improvement to quality of life with a focus on outcomes and access – how can we ensure that children with asthma have control over breathing? Does a person have access to effective therapies to recover from an accident? These questions bring us towards solutions such as home and community based services that provide a higher quality of life. Cost savings may be also be achieved, because prevention is frequently more cost-effective.
3. Does this proposal suggest that healthcare is a right or a privilege?
Proposals generally start from one of two premises – either healthcare is a right or a privilege. On the “rights” side healthcare is a service you should be guaranteed access to regardless of means. For example, when a person entering an emergency room receives care regardless of ability to pay. Alternately, on the “privilege” side, healthcare is a service that each person should “earn” through contribution. These proposals focus on employer-based and private sector solutions where individuals can earn better healthcare by different career choices.
Once you’ve asked yourself these questions about each proposal you read, you may find that perhaps you’ve changed your mind. Proposals often contain a mix of these, but trend to one side or the other. We all may answer these questions differently – the most important one though is did we ask some in the first place.
How do you decide?