Health care system at the brink

by John H. Anderson

Having spent approximately forty years in the health care industry in various roles, including that of CEO, and now in a retired status for the past fifteen years, I have an accumulation of experiences and observations from which to reflect on where we are, how did we get here, and what’s ahead.

In the 1930s, health insurance was a new concept, motivated by non-profit entities such as Blue Cross by which the individuals could handle hospital bills, this in association with non-profit hospitals mostly church related or publicly owned. Blue Shield came along later by which professional medical care, largely surgically related, to be a prudent add-on to meet health care costs and to be a reliable source of payment for medical professionals.

Later the purchase of health insurance moved from an individual’s choice to an employer-paid benefit, in which the employee, the patient, was effectively shielded from the burden of cost decisions in accessing health care. This compounded in 1965 with the creation of tax supported Medicare, followed by Medicaid. Thus the population largely consuming ever-increasing amounts of health care without regard to the ability to pay…for a costly product.

The next major event was the emergence of a societal assumption that health care is the right of all, minimal or extensive care, regardless of means of payment. This became dramatically apparent to me in 1991 while as CEO of a Blue Cross Blue Shield organization when public outcry, media driven, made it impossible to abide by the terms of the contract between Blue Cross Blue Shield and the individual…a treatment costing approximately $250,000 (at that time), even with life expectancy very limited. This one incident, understood to be motivated by a heart of compassion became to me a demonstration of the problem. Who is to pay? This $250,000, and how many others, was not what was purchased. That cost was borrowed from other Blue Cross members in the form of subsequent rate calculations. To be sure all companies have expenses that may seem irrelevant to their product pricing, but these are not as philosophically driven by societal pressures as is true in health care. When applied to Medicare or Medicaid these costs are rolled up into taxes and federal debt.

Other major exacerbating factors, beyond the right of health care, each very large, such as: (A) the increasing recourse to legal action by patients when practitioners of health care have been alleged or proven to be negligent in unfavorable health outcomes, driven both by the patient’s circumstance and attorneys anxious for clients with fees as a percent of lawsuit awards, but frequently “settled” to avoid costs of litigation, (B) the patient’s desire coupled with the health care provider’s income need, for all potential forms of treatment for diseased or disabled bodies. This being especially prevalent in the last months of life, (C) capital available in anticipation of future profit for all types of products and new modes of treatment, which spawn ever increasing specialties, sub specialties, in the practice of medicine, personal and products.

This has resulted in a perfect storm, which has come to a climax at a time when this entitlement is no longer affordable due to it being the out of control driver of an unsustainable national debt in addition to the cost of insurance premiums unaffordable for many. It is a financial burden on corporations seeking to sell products in a global market in which the competition has no such similar sized burden.

One way or another there will be a solution, orderly or catastrophic. Lack of congressional action will result in the catastrophic, pushing the national debt and premium costs past the breaking point with enormous societal impact.

There will be either political action or inaction in the very near timeframe, either of which will have major impact. Inaction due to political/moral paralysis will ultimately yield the catastrophic.

Action will emerge in either of two primary forms: a revised semi-competitive private health care insurance market or a government managed solution, such as Medicare/Medicaid.

With either solution there will be rationing of care. If it is in a private market, this will be in the ability to pay either up front by insurance premiums or at the point of care. If in a public market, it will be by governmental regulation…care for some but not all in either scenario.

In the latter public model the morally relativistic culture will likely prevail with a strong bent toward a secular-humanist world view…i.e. abortion rights, transgender procedures, likely euthanasia and limited care for the disabled and elderly?

In the private insurance model based on prevailing thinking, there will be room for differing world views, religious or secular in the language of benefits and exclusions. Recognizing however, that the influence of major corporations will be slanted to the secular world view…note the recent recision of the North Carolina bathroom bill.

Christian reflection: Understanding that health care in its inception and until recently was recognized as a province of the church, formally and informally…compassion for my neighbor. This has largely disappeared, with these entities being “managed” by governmental regulations and by payment modalities. The motivation to compassionately serve is perhaps still there, but this compassion is subordinated to the politically calculated interests of the state.

In this charged political environment what should be the role of believers, church entities? Should we be less concerned than 100 years ago when the church in its various forms created the health care institutions? Or do we stand on the sidelines as the parade goes by and not engage the issue with clear minds and caring hearts. Unfortunately, to engage, participation in the political world is required.

Supplemental to the above that dealt with the most basic issues, is that of cost of the care being delivered.

At 17% of GNP and climbing, current health care cost is not sustainable with the economy competing in a global market. Nor is the astronomic premium cost for insurance paid by individuals.

To seriously address this issue would be a monumental (and achievable?) political undertaking. Speaking not pessimistically, but realistically, I don’t have much hope. Key entrenched bastions of self-interest would have to undergo fundamental change…pharmaceutical industry, advertising, legal professionals, medical specialties, care expectations of the public, profit expectations of the players in the market, etc.

New healthcare delivery systems must be conceived and allowed to exist so that costs could be meaningfully reduced without retreat in quality.

Perhaps a demonstration project, such as in a sizable community of about 100,000 people, could be created, in which these and other reforms could be developed. Such a community project would need to be managed by public/non-profit entities working in collaboration with representative health care providers. Worth thinking about?

In summary, this monumental challenge requires enlightened leadership and a society willing to rise above self-interest.