The ultimate paradox is that our ever-increasing expenditures on health care are, in the long run, reducing overall population health and quality of life for society!
There are more than enough good policy proposals for reining in health care costs. The basic impediment is that we – the body politic – are afraid of change. Our fears are like musical instruments for all of the economic interests that are threatened by constraining expenditure – they can play on our fears and thereby undermine (thus far) even the wisest of policy proposals.
The most recent Kaiser Family Foundation publication – “Moving Away from Employer Based Coverage: Don’t Forget Public Opinion” – adds to our understanding of the barriers to change. There isn’t much to say on behalf of anchoring a health insurance system in employment except that it happens to be the way we manage the process in the U.S. But when a Kaiser Foundation tracking poll asked how people felt about the prospect of shifting to employer based insurance to self selected (individual) insurance, 60 % - 80 % felt that the shift would make things worse for them.
In presenting the report, Drew Altman comments:
Health reformers have learned the hard way in the past that whatever the appeal of policy proposals on their merits, they ultimately have to be acceptable to the public or they will not fly...It is an old law of health reform that despite frustrations with the health care system and a general desire among the public for reform, the burden is always on reformers who would change how people get their health care and health insurance today. That’s why the easy answer -- though not necessarily the right one -- is to assure people that they can keep what they have today.
Fear of fundamental change has led political leaders to opt for incrementalism. But incrementalism, like patching the Titanic, doesn't work. Findings like the Kaiser Foundation tracking poll suggest that we should only expect to see a combination incrementalism and wishful thinking in political campaigns. Whether or not moving to individual purchase of health insurance is a good idea, the poll tells us that genuinely fresh ideas are too risky. The most we can hope for between now and November is education of the public about the causes of cost escalation so that after the election we may be better prepared to respond to bolder leadership.