What exactly is the problem with the American health-care system?
The problem is not that Americans don’t have fine doctors, medical technology, and treatments. American medicine is the envy of the world. The problem is not that most Americans lack adequate health insurance. The vast majority of Americans have private insurance, and our government spends many billions each year to provide even more.
The biggest problem with the American health-care system is one of cost and access, and as a result tens of millions of individuals have no insurance. For example, we currently spend for about 2.4 trillion dollars a year on health care. A decade from now that number, under current projections, will double to over four trillion dollars.
The Obama and Clinton response to these problems is to promise universal coverage, whatever its cost, and the massive tax increases, mandates, and government regulation that it imposes. But in the end this will accomplish one thing only. We will replace the inefficiency, irrationality, and uncontrolled costs of the current system with the inefficiency, irrationality, and uncontrolled costs of a government monopoly. We’ll have all the problems, and more, of private health care — rigid rules, long waits, and lack of choices, and risk degrading its great strengths and advantages including the innovation and life-saving technology that make American medicine the most advanced in the world.
I have a different approach. I believe the key to real reform is to restore control over our health-care system to the patients themselves. To that end, my reforms are built on the pursuit of three goals: paying only for quality medical care, having insurance choices that are diverse and responsive to individual needs, and restoring our sense of personal responsibility.
American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. Health Savings Accounts are tax-preferred accounts used to pay insurance premiums and other health costs. They put the family in charge of what they pay for, and should be expanded and encouraged.
Americans also need new choices beyond those offered in employment-based coverage. They want a reformed system so that wherever you go and wherever you work, your health plan goes with you. And there is a very straightforward way to achieve this.
Under current law, the federal government gives a tax benefit when employers provide health-insurance coverage to American workers and their families. This benefit doesn’t cover the total cost of the health plan, and in reality each worker and family absorbs the rest of the cost in lower wages and diminished benefits. But it provides essential support for insurance coverage. Many workers are perfectly content with this arrangement, and under my reform plan they would be able to keep that coverage. Their employer-provided health plans would be largely untouched and unchanged.
But for every American who wanted it, another option would be available: Every year, they would receive a tax credit directly, with the same cash value of the credits for employees in big companies, in a small business, or self-employed. You simply choose the insurance provider that suits you best. By mail or online, you would then inform the government of your selection. And the money to help pay for your health care would be sent straight to that insurance provider. The health plan you chose would be as good as any that an employer could choose for you. And if a church or professional organization wishes to sponsor insurance for its members, they should be able to do so. The bottom line: Health insurance would be yours and your family’s health-care plan to keep without worrying that it will go away along with your job.
The value of that credit — 2,500 dollars for individuals, 5,000 dollars for families — would also be enhanced by the greater competition this reform would help create among insurance companies. Millions of Americans would be making their own health-care choices again. Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs. It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost. Again, choice and competition are indispensible to real reform that brings costs down and broadens access while maintaining quality.
But we also need to ensure that those without prior group coverage and with preexisting conditions, who have the most difficulty in the individual market, have access to the high-quality coverage they need. As with other problems our nation has faced, states have taken the lead in experimenting with ways to cover the “uninsurables” and give us a window into what works and what doesn’t work. I will consult with the governors to solicit their ideas about a best practice model that states can follow — a Guaranteed Access Plan or GAP — and work with Congress, the governors, and industry to make sure that it is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs. The details of a Guaranteed Access Plan would be worked out with the collaboration and consent of the states that wish to participate.
This cooperation among states in the purchase of insurance would also be a crucial step in ridding the market of both needless and costly regulations, and the dominance in the market of only a few insurance companies. Right now, there is a different health-insurance market for every state. Each one has its own rules and restrictions, and often guarantees inadequate competition among insurance companies. Often these circumstances prevent the best companies, with the best plans and lowest prices, from making their product available to any American who wants it. We need to break down these barriers to competition, innovation and excellence, with the goal of establishing a national market to make the best practices and lowest prices available to every person in every state.
Families also place a high value on quickly getting simple care, and have shown a willingness to pay cash to get it. If walk-in clinics in retail outlets are the most convenient, cost-effective way for families to safely meet simple needs, then no policies of government should stand in their way. And if the cheapest way to get high quality care is to use advances in web technology to allow a doctor to practice across state lines, then let them.
Effective reform must also deal with another source of needless cost and trouble in the health care system which comes from the trial bar. Every patient in America must have access to legal remedies in cases of bad medical practice. But this vital principle of law and medicine is not an invitation to endless, frivolous lawsuits from trial lawyers who exploit both patients and physicians alike. We must pass medical liability reform, and those reforms should eliminate lawsuits directed at doctors who follow clinical guidelines and adhere to patient safety protocols. If Sen. Obama and Sen. Clinton are sincere in their conviction that health care coverage and quality is their first priority, then they will put the needs of patients before the demands of trial lawyers. They can’t have it both ways.
Finally, we must personally do everything we can to prevent expensive, chronic diseases. Our rights in this country are protected by our personal sense of responsibility for our own well being. Cases of diabetes are going up, not only in the baby-boom generation, but among younger Americans obesity, diabetes, and high blood pressure are all on the rise. Parents must impart to their children a sense of personal responsibility for their health, nutrition, and exercise.
We can build a health care system that is more responsive to our needs and is delivered to more people at lower cost. The “solution,” my friends, isn’t a one-size-fits-all-big government takeover of health care. It resides where every important social advance has always resided — with the American people themselves, with well-informed American families, making practical decisions to address their imperatives for better health and more secure prosperity.
– John McCain is a Republican senator from Arizona who is currently running for president.