I have had the privilege of interviewing both President Obama and former Massachusetts Governor Mitt Romney about health care reform. I say “privilege” because I found them both to be well-informed and deeply concerned about needed changes in American health care. And as many have observed, I also found the two key elements in each of their plans — mandated insurance and insurance exchanges to make choices easier — to be almost identical in concept.
However, given that the presidential campaign is very much about the role of the federal government in our lives, it is not surprising that there is a huge difference between them in terms of that role in health care — as was clear in the first of the presidential debates. Today, Romney tries to distance himself from the strong government role in his Massachusetts plan with a states’ rights mantra: His plan was good for his state then, but every state should develop its own plan. But when it comes to “life and death” sectors in our economy, it may be that states’ rights can be dangerous, even fatal.
Consider a life-and-death industry that is extremely competitive in the private marketplace but under the heavy regulation of the federal government to the benefit of all Americans — the airline industry. Would you feel comfortable allowing each state to decide how often planes should be inspected and pilots recertified? Can you imagine getting on a plane and having to wonder how that state handles such issues?
Amazingly, that is what we essentially do now with health care — and the effects of this lack of robust federal supervision are disturbing. For example, the independent Institute of Medicine estimated in 1999 that almost 100,000 Americans die every year because of medical errors. Compare that disastrous record to the incredible safety record of the airline industry, which is under the tight control of federal agencies composed of independent experts who are not beholden to politicians and lobbyists.
The Institute of Medicine also recently released a report indicating why appropriate federal supervision of health care is needed. It concludes that about 30 percent of total US health care costs in 2009 — $750 billion — was wasted on unnecessary services, excessive administrative costs, and other problems. Today, it would be over $800 billion. That’s enough money to provide basic health care to all the uninsured in this country. But that wasteful spending is one reason why this country — the richest country in the world, which spends twice as much per person on health care as the average of all other developed countries — is still the only developed country that does not provide basic health insurance to all its citizens. We are so busy spending money on things that don’t work that we don’t have enough to provide basic care for everyone.
The Centers for Disease Control and Prevention has found that 67 million Americans have high blood pressure, but only 31 million — fewer than half — were aware they had it and were being treated effectively. In response, a New York Times editorial closed with two sentences that encapsulate a basic problem with American health care: “The benefits of reducing high blood pressure — not to mention the cost savings — are obvious. The wonder is that the health care system has done such a bad job of delivering those benefits.”
Actually, it is no wonder at all — it is entirely predictable. We too often do not do the “obvious” precisely because there is no such thing as a national health care system to make sure it gets done.
We in Massachusetts are fortunate to have political, insurance, and medical leaders who are committed to quality and cost control. But that is not true in many other states. And simply letting each state design its own system would be a disaster: 50 legislatures subject to the pleadings of industry lobbyists, with the lives of patients potentially at risk as a result.