Why government cannot cure our health care

There are few things more important than our health and our health care. Solving health care for everyone is critical to becoming a healthy, vibrant society. Because our government has controlled our health care for two generations, election realities and political rancor obscures our ability to collectively solve the problem. Allow me to use a fictitious government program, “Foodaid,” to defray the noise and illustrate how government-control of our health care is the problem and not the solution.  Thankfully, the private sector is showing us a way forward.

Imagine if our government managed how we purchase food like it does our health care industry. That is, instead of food stamps, where individuals use vouchers to buy food in a transparent and competitive marketplace, the government controlled the entire industry. Foodaid (for our most needy) and Foodcare (for seniors) would manage all transactions; real prices for food would be unknown. Those lucky enough to be employed may have FoodCross and FoodShield cards that allow them to shop at Trader Joe’s and Whole Foods. All others would be in a single check-out line staffed by TSA types that make certain that you are “buying” your mandated rice, fish, and kale that industry lobbyists were able to foist into your shopping cart. Grocery stores would be massive with wonderful marble entryways and maybe even a water feature.

Ridiculous? Yes, absolutely.  However, this is essentially how our government has controlled our health care for 50 years. This third-party government control of the industry makes the provision of care costly and inefficient and it opens the door to all manner of fraud, waste and abuse. This may be one of the reasons that, per capita, Massachusetts is one of the most expensive places in the world to obtain health care.

The real problem with government control of our health care is that political realities trump the needs of the citizenry.  That is, inside the beltway, contributors matter much more than constituents.  Ryan Grim wrote about these realities regarding the VA scandal recently in the Huffington Post. He writes that the average politician must spend 4 hours per day fundraising. It should come as no surprise then that as the deliberations of the Affordable Care Act (ACA) were proceeding during the recession of 2009, lobbying contributions reached an all time high with health care leading the way. Even more telling is the revelation by Glenn Greenwald in the Guardian that much of the ACA was written by an insurance industry lobbyist.  This may help explain the ACA’s lack of a public option and a reinsurance tax placed on every American as a hedge for, you guessed right, the insurance industry.

John Mackey, the CEO of Whole Foods, had our answer to health care in 2009. His decentralized, collaborative and empowering model for care solves both our cost and access challenges. By  self-insuring their health care employers have embraced these account-based health plans that is the basis of Mackey’s solution.

This will drive transparency and competition in our health care sector and begin the dismantling of our overpriced government health care industrial complex. That is if politicians (and lobbyists) don’t intervene.

Matt McCord is an anesthesiologist. He is founder, Michigan Alliance for Sustainable Healthcare, and can be reached on Twitter @MattMD.

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  • http://www.loveyourniche.net LoveYourNiche

    I’ve always felt these comparisons don’t do enough, perhaps deliberately, to distinguish between government managing the payment structure and doing some regulation (which may be too much, and the actual discussion at hand), and managing payment AND supply. Most of us simply aren’t dealing with a healthcare reality that is analogous to the VA experience.

  • QQQ

    The government is supposed to handle a few basic things:

    Keep our infrastructure sound
    Protect our border.
    Protect our interests here and abroad.

    The states are to control their own individual interests within their own state lines

    Each state is (or was) supposed to be a sovereign nation unto itself. That’s why we’re called “The United States of America”. That is why the ACA is unconstitutional and that’s why the FEDERAL government should stick to what the founders defined it’s limited powers to be, and the states to keep the powers THEY were given to do what’s best for each
    individual one.

    BOTH parties need cleansing!

    Thomas Jefferson was quoted as saying the government should be cleared out and completely re-elected every 25 years because by then big business and corruption will taint the representation of its people.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Love the Foodaid/Foodcare crosses and shields terminology…. Unfortunately there is no resemblance to Medicare, Medicaid and the Blues.

    First, unlike the Foodland situation where “real prices for food would be unknown”, the prices for every single Medicare and Medicaid service and product are publicly known to the last cent (and always have been).
    The only place where prices are unknown is the private insurance market.,

    Second, unlike Foodland, those with Foodcare and Foodaid cards provided directly by the government are free to shop at any Trader Joe or Whole Foods of health care, while the holders of FoodShield and FoodCross plastic cards, whether purchased by their employer, by the government, or directly by the consumer, can only shop where they are told to shop by the Shields and Crosses, places like Food-for-Less and Leftovers-R-Us.

    Oh, and the reason that Massachusetts is so darn expensive is that all the Food Emporiums were allowed to get together and create a cartel…

    Other than that, I agree with assigning the blame for this situation to the plague of campaign financing and lobbyist highjacking of our political system.

    • Eric W Thompson

      Umm, the prices for Medicare and the like are set and not linked to true cost. In many instances below cost. This forcing the providers to charge the rest of us more.

  • Sandy Mehall

    This is an excellent analogy and makes it understandable to the layman…if only it got more traction with the liberal media…sigh, guess I can wish!

    • Matt McCord

      Thanks very much Sandy.

  • Matt McCord

    Thanks for all the great comments everyone. Thanks for contributing to the discussion and encouraging others. It is challenging to cover a concept related to healthcare within 500 words. You will be happy to hear that, now that everyone has super-sized deductibles, there are many new entrants working on pricing transparency in healthcare: http://

    bit.ly/1hFHAO2

  • Matt McCord

    Here is a great summary of the rise of the on-line healthcare marketplaces from the California Healthcare Foundation: http://bit.ly/17vUHu6

  • Matt McCord
  • logicaldoc

    It is wrong to blanketly claim that Government has no role in Healthcare. All these comments prove to me is that everyone, even in my Profession, needs to read my first book. The answer lies by going years and years back to finding out the core illness that infected the Patient-Physician relationship. And this was another Profession, in the Private Sector, that saw a Market with a naturally high prevalence of negative outcomes, was free to roam without Oversight and Regulation (this is where Government’s role should be), and spiraled healthcare costs out of control. This has been 35 years in the making and people still want to just put band aides on the problem; or resolve their dissonance by focusing their negativity on the current Administration. I’m so tired of nearsightedness.

  • querywoman

    I agree that government cannot cure health care. Neither can private insurance. So make all third party reimbursement systems illegal. Then prices should drop.
    Then, maybe medical students won’t have to take huge government loans to finance their educations. So you think taking a school loan is not being on the government trough because you have to pay it back? Sorry, folks, it is the government trough. I didn’t get any federal aid money for my bachelor’s degree.

  • Jim Pagano, MD

    Cost-based pricing, transparency, and getting the insurance companies and government out of the way are what’s needed. Health insurance should be just that, a backstop for catastrophic costs. Health savings accounts, tax advantaged and large, with high-deductible insurance as safeguard; healthcare debit cards issued by the government to those who cannot afford a savings account, rated by income level; a safety net, like Medicaid for the truly indigent, non-citizen, etc., and a cash-based payment model would drop prices, increase patient awareness of their healthcare needs and of the best way to spend their healthcare dollars, and would be cheaper overall than the bloated and inefficient system we have now. Politicians do not have the will or incentive to do these things. Both the insurance companies and the government want control with minimal risk. It is going to be up to us as voters and healthcare professionals to change the direction in which we are headed.

    • Matt McCord

      Amen Jim. Fortunately, the private sector has already moved a great deal in the direction that you describe. Another missing element, however, is a real quality metric that consumers can understand. This is one area where the government can (and should) help as Dr. Peter Pronovost suggested: http://bit.ly/19NShX5

      • Jim Pagano, MD

        Matt,

        My 2 cents were added extemporaneously. Thanks for the response. The subject deserves a more in-depth discussion, which I would like to engage off-line. I looked at the post Dr Provost wrote. It is compelling and intelligent but it addresses only part of the problem, a vital part no doubt, but only a part. Somewhere among the metrics, the quality analyses, the art and the science of what we do, lies the rest of what we are trying to solve. I believe that only we, as committed professionals, have the most to say about how this comes about. I’m new to the blogosphere and had a bit of beginner’s luck with my first post. I would like to parlay that success into a deeper discussion.
        Jim
        jamesvpagano.com
        jpagano@precisionscribes.com

  • Matt McCord

    Here is another fabulous and thorough article on how government managed healthcare increases our costs and limits our access to care: http://herit.ag/1smjnmW

  • SteveCaley

    Cultures and civilizations quite frequently march to their demise from problems clearly seen but never addressed. The end of medical care in the US is one such case. Look at the great extinct civilizations, which handled almost everything needed for advancement excellently for many centuries; and then died at their own hand of stupidity.
    All civilizations die as fools – perhaps we know our own fate. Healthcare is an organic essential of common human existence, and is active in every tribe and civitas to a greater or lesser degree. Ours may ruin it here. So be it.