Who knows how to fix the U.S. healthcare system? According to MIT economist Amy Finkelstein’s family, she should. After she spent two decades studying U.S. health policy with Stanford economist Liran Einav, her longtime collaborator, Finkelstein’s father-in-law stumped her with a question: “Why don’t you know what we should do?” he asked. We’ve Got You Covered (Portfolio, July), coauthored with Einav, is Finkelstein’s response.
How did the U.S.’s healthcare system become so broken?
Our healthcare policy has emerged haphazardly over the last 70 years as various issues became salient in the public mind and there was a public policy response to them. These responses were well-intentioned, but inadequate. In the late 1960s, many people were dying of end-stage kidney failure, despite the creation of dialysis machines, because they couldn’t afford to access them. Life wrote a story, politicians wheeled end-stage renal disease patients into the halls of Congress, and suddenly Medicare coverage was extended to all end-stage patients, regardless of age. The problem is, none of these programs end up being sufficient. It’s a patchwork
approach. We never took a step back to look at the whole thing.
What have we learned from Covid-19?
There’s nothing quite like a public health emergency to make you see the inadequacy of the public healthcare system. A major problem is that about half of Americans get insurance through their employer or a family member’s employer. When you lose your job and your insurance, you have to pay the whole thing out of your now-diminished money. $140 billion is now held by collection agencies in medical debt. This is as much as collection agencies hold for all other consumer debt combined.
Why does the U.S. lag so far in adequate healthcare?
When you look at history, we have the same goal as other countries do, and the same long-standing tradition of trying to help people in dire medical straits. Why haven’t we succeeded? It wasn’t the destiny of other countries to have universal coverage, nor was it our destiny not to. In Canada, doctors went on strike when universal coverage was introduced. The short answer is we got unlucky, but we can recover.
Now for the trillion-dollar question: How can we fix the U.S. healthcare system?
More reform, as well-intentioned as it is, can’t work. Rather than patchwork fixes, we need to design basic universal automatic coverage up front, with the option to buy more in a well-functioning private market. And basic means basic—not private hospital rooms, not seeing the doctor of your choice when and where you want. A lot of what we’ve talked about sounds like a “liberal” proposal, but our argument has been made by conservatives. It’s not a Democratic or a Republican proposal—it’s just good sense. Our intention is to hold to the social contract: not to let people die in the streets.
