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As the health-care reform debate heats up, we are hearing more and more one-sided arguments on the issue. Usually presented with some tragic anecdote, these reports seem to indicate that any opposition to the particular position being argued is downright un-American, and brands the person disagreeing as belonging to a "special interest."

The time has come to tell the real story about the health-care "crisis" in this country.First of all, the real problem with health care is cost, not access. If there were no cost problem, there would eventually be no access problem. Sound obvious? Think about it. If costs were under control, a way could ultimately be found to pay for everyone. True "universal coverage" would result. Under many current "reform" proposals, costs would only continue to rise.

So where does the cost problem come from? At the most basic level, it stems from the fact that individuals are totally removed from financial consequences of their health-care decisions. With third-party payment mechanisms and uninformed consumers, no economic checks and balances exist. The solution is simple: Individuals must be better educated and more accountable for health-care decisions. That is why the idea of medical savings accounts (which would give consumers the incentive to make efficient choices in their medical care, while still protecting them against financial hardship) makes so much sense.

The second part of the cost problem arises from the failure of our society's medical ethics to keep up with rapidly advancing technology. We allow medical science to do everything it can, regardless of the cost. Time was, "everything" was quite limited. But now, with the explosion of advancements in medical technology (created in large part by U.S. private industry research), there is often literally no limit to what can be done, and how much can be spent, even when the best-case scenario is much less than ideal.

We cannot afford to continue with unlimited spending. But who decides where to draw the line? I hope it isn't the government.

There are no "villains" in health care. Even the much-maligned health insurance industry only introduced the now-infamous "medical underwriting" when employers with healthy employees demanded a lower-priced product, in spite of skyrocketing medical costs. I am not aware of a single insurance company that does not support extensive insurance reform to "level the playing field." What they oppose is a massive new federal entitlement program with untried methods. Every segment of health-care delivery, from hospitals to physicians to insurers, simply responds to the realities of the health-care environment in order to survive.

What is needed now is not necessarily health insurance for everyone (by itself that would offer no long-term solutions), nor a massive overhaul of the financing mechanism that leaves the root causes untouched. We need to address the disease, not the symptoms.

Michael Bush