When the president said, “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection,— he was exactly right.
It wasn’t President Barack Obama who said these words, although he has said many things just like this. It was Harry Truman as he spoke to a joint session of Congress in 1945.
Things have changed dramatically since then. Former Secretary of Health and Human Services Mike Leavitt tells audiences that he was born about the time when Truman addressed Congress. At that time, health care was about 4 percent of our gross domestic product. By the time his children were born, that figure had risen to 8 percent. Another generation later, that figure has doubled again to 16 percent.
There is no end in sight. The numbers continue to climb exponentially. The president’s Council of Economic Advisers recently released its report on health care costs. Assuming a growth rate
of merely 4 percent, the projected premium payment for a family of four in 2025 will exceed $25,000. Before long, one out of every five dollars spent in the U.S. will go to health care. And estimates are that we will spend at least $35 trillion in the U.S. within the next 10 years alone.
We might be willing to accept these prohibitively high costs if we were getting great value from the investment. But the truth is that the quality of our health care is actually declining despite of all the technological innovations that we have witnessed in recent decades.
Health care in any society looks like a pyramid. The base of the pyramid comprises basic health care delivery involving wellness and prevention. It is the least costly. As we move up the pyramid, the care becomes more sophisticated and technologically advanced. At the peak are the most costly and technologically advanced applications, such as organ transplants, available in modern medicine today.
Every country begins at the base of the pyramid and works its way up until the money runs out. However, in the U.S., we start at the top of the pyramid and work our way down until the money runs out. This is our fundamental problem.
We have an inverted pyramid that costs over 40 percent more than the second-most-expensive country. At the same time, quality declines because we ignore the most basic, least expensive form of health care delivery. As a result of the extraordinary spectrum of quality and quantity found in this country, we have islands of excellence (Mayo Clinic and Intermountain Healthcare) in a sea of mediocrity.
This mediocrity is exacerbated by the disturbing fact that now nearly 50 million Americans have no health insurance at all at some time in any given year. Add to that the realization that nearly half of all Americans who have insurance don’t have adequate coverage to get the care that they need.
As a result, one can quickly begin to understand the remarkable complexity of the problems that we face involving cost, quality and access. Given these problems, what are the principles upon which we can address the growing health care crisis in America today?
I propose that there are at least five:
First, we must build on the system that we have. Americans want an American solution. We have a public-private system today, and we should work to make it better. Radical change cannot be successful.
Second, a comprehensive plan to address cost, access and quality is essential. Incremental policy change has been tried now for 15 years and has largely failed to address the growing problems.
Third, modernization of our health system is a must. It must start with health information technology; it must include evidence-based medicine and best practices; it must incorporate the maximum amount of transparency; and it must be managed in such a way that we begin to tear down the stovepipes that dominate the system today.
Fourth, we must invert the pyramid. We must change the paradigm from illness to wellness. We simply cannot improve cost, access and quality without doing so. This responsibility must fall within the health care system, but the system alone cannot be responsible. Our schools, our businesses, our communities and our families must all understand that an emphasis on wellness is fundamental.
And fifth, we must have coverage for all Americans. Everyone must be brought into the tent. That will end cost shifting and help us make our health system vastly more efficient.
The time has come for America to end the distinction as the last industrialized country in the world to have failed to do so.
Many people from around the country to whom I have spoken have said that these goals are simply impossible. But one of my heroes, Nelson Mandela, once said that “many things seem impossible until they are done.—
Harry Truman would agree.
Tom Daschle is a former Senator from South Dakota and served as Senate Democratic leader. He is currently a special policy adviser at Alston & Bird.