Lesson 9: Healthcare as a Utility

Healthcare Lessons for Policymakers

Our conversations about healthcare coverage do not hit the mark. One political party talks about healthcare as a right. The other talks about healthcare as personal responsibility. Meanwhile, our healthcare system does not serve our needs. Our care is twice as expensive as care in other developed countries. We must have a more rational discussion if we are to make progress in providing better health at lower cost.

Healthcare is most like our community water supply. In most towns and counties, the municipal or county government has a water authority that makes certain there is plenty of good, clean water available to every home and business at a fair price. Everyone understands that every person and every business needs that resource, that it is a life or death issue, and it is in everyone’s interest to have a water supply that is reliable and affordable. One thing is certain, if your community does not have a reliable water supply, it is very difficult to attract jobs and business.

Healthcare is most like that. Sooner or later healthcare becomes a life-or-death issue for most of us and everything that I have said about water could be applied to healthcare. Every American should have access to basic primary care that is affordable and works for them. We all have a stake in that because chronic diseases generate 86% of healthcare costs in this country. Because we don’t have a rational system, health insurance is becoming unaffordable. We can treat high blood pressure, diabetes, and high cholesterol in primary care very inexpensively. When we don’t do that, Americans develop expensive complications like chronic kidney disease, heart attacks, strokes, and congestive heart failure. These chronic diseases are driving the cost.

We don’t provide inexpensive primary care to keep some people healthy, but when a poor black American needs dialysis, they automatically go on Medicare, and we do pay for that. It is a hundred times more expensive. It makes no sense. It is like not having a community water supply and being surprised that the community does not prosper. The more complications that result from a lack of care for high blood pressure, diabetes, and high cholesterol, the more expensive care becomes. It is very important to realize that the very people who cannot afford basic primary care services are the ones who are most likely to  develop chronic diseases like hypertension and diabetes. They are the ones who are most likely to develop expensive complications. It is penny wise and pound foolish to do away with the Affordable Care Act. We should make sure that every American has access to these basic primary care services.

By providing basic primary care services for everyone, we would have a healthier population. By treating diabetes and hypertension inexpensively, we would avoid more expensive complications later. The rest of the developed world has figured this out. They live longer for half the money. Better primary care is less expensive care. Other nations use several different models to be sure that those who need medical care the most get it. Most Germans get their health insurance through their employer like we do, but they do provide healthcare coverage for those who cannot afford it. Why wouldn’t you want to do that if the end result is lower medical costs and healthier neighbors?

There is one caveat. Just covering more people is not the whole answer. Remember the best care is the least expensive care. If taxpayers are helping to pay for some care, they should insist that the clinicians use “evidence-based care processes consistent with best practices.” That is the kind of care that means you are ten times more likely to be alive 5 years after a heart attack. More on that in the next lesson