Asking whether American health care should be private or public is like asking whether a house should be built with wood or cement. The answer is always both. This is why all developed countries have a mix of private and public health care.
The United States has a uniquely expensive health care system. We spend 50 to 100 percent more than other developed countries on health care, whether that is measured as percentage of GDP or per capita (healthysystemtracker.com.) We get unusually poor results despite that expenditure whether it is measured by life expectancy (CBS News), mental health (ourworldindata.org/mental-health) or infant mortality rate (healthysystemtracker.com.) Even worse, we are the most obese (worldobesitydata.org) and most drug addicted developed people on the planet (United Nations data, un.org). We have lost our way.
The problem is not public vs. private, cement vs. wood — we need both. The problem is the house design. We have a system in which insurance companies, hospitals, pharmaceutical manufacturers, nonprofits, doctors, equipment manufacturers and the research industrial complex chase public and private money like drunks at a feast. Add layer after layer of state and federal regulations (often written with the best of intentions) and the billions spent on lobbying by “stakeholders” and you have a truly dysfunctional mess. Imagine a house with a million dollar budget, no general contractor and the subcontractors writing their own checks. In the end the house could look pretty crazy.
What health care really needs is a blueprint and a general contractor who, with knowledge, experience and common sense, negotiates with subcontractors and manages overall construction focusing on cost and quality. A building code is fine, but it should be tempered with common sense. The contractor would have to be the government, something like the Marines, an agency built on integrity, honor, courage and commitment. It would have to have full control over the mission. The mission would be to leave no patient behind, to provide the best and most cost-effective care on the planet. Serving in this agency, like the military or NASA, would be a calling, not just a job. Every employee should feel like her real boss is the American people. We have the world’s best military, and we could have the world’s best health care system.
What would happen to the insurance companies, hospitals, pharmaceutical manufacturers, nonprofits, doctors, equipment manufacturers and researchers? Those that provide good service at a reasonable price would flourish. Medical school and other training would be free, like West Point. Doctors would pay back with their service. The highest-ranking medical professionals would make about what generals make. Pride would make up for any loss in pay. Insurance could be entirely private like Switzerland or primarily governmental like Great Britain.
Medical clinics would function like platoons. Every citizen of the United States would have a well trained MD as a primary care provider. We would have a universal electronic medical record as in other countries. Basic needs such as diet, exercise, stress management and sleep would be addressed in quartermaster fashion. Pharmaceutical and medical equipment cost would be controlled by the platoon and the Chiefs of Staff.
Eisenhower warned of the “military industrial complex” (and this has certainly come to pass), but it is nothing compared to the “medical industrial complex” that has gutted the integrity, honor, courage and commitment of medicine. Eisenhower believed the military was too important to be left to the immorality of the almighty dollar, too important to be left to industry. The same can be said of medicine. This does not mean entrepreneurial enterprise and financial profit abandon their roles as primary engines of change. However, it means the private sector is given a “mission” and a set of rules based on a deep commitment to the country above and beyond the almighty dollar.