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Mallary: Health care reform

05/12/09 7:55AM By Dick Mallary
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(HOST) Commentator Dick Mallary has come to believe that health care reform is possible - but only if we are willing to accept some uncomfortable realities.

(MALLARY) For too many years, we have been aware that our system for the delivery of health care in Vermont and the United States is unsatisfactory.

Despite all the improvements in knowledge, pharmaceuticals and technology, much of the public is still deeply dissatisfied with our system to provide health care. President Obama made this an issue in his campaign and he promises to address it during his first year in office.

In the United States, we are now spending far too much on health care - more than 17% of our gross domestic product -- and the share continues to rise. This is significantly more than is spent in any other country on the globe. While we have expensive and often excessive health care for some, many citizens do not receive the essential care that they need.

There are lots of reasons for this. Our population is aging and older people generally require more health care. We have developed many new and expensive pharmaceuticals and medical procedures. And some of these medical procedures are overused because they are more profitable or because the providers are practicing defensive medicine. Insurance mandates by the states have driven up usage and the cost of insurance coverage. We spend enormous sums for care at the end of life with little benefit - and often great distress - to the patient. And finally, most health care is not paid for directly by the patient receiving the care, Instead, it is paid by a third party - either government or an insurer -- so the patient doesn't know or consider the cost of his care.

We can't have a rational, orderly and humane system to provide health care at a reasonable cost until we ration - yes, ration - the care being provided so that all citizens get the basic or essential care that they need but the cost of unnecessary, wasteful and marginally beneficial care does not become a burden on society.

I used to think that Vermont might be able to solve this problem in an incremental, piecemeal fashion. But, with open borders, a transient population and Federal control of much of health care funding and regulation, I now know that that Vermont can't do it on its own. Furthermore, I have come to believe that our political system doesn't have the courage to endorse the concept that there should be limits to what care the public can guarantee.

So, it now appears to this old, fiscally conservative Vermont Republican that the only way to break the cycle of growing costs and inefficient health care delivery is to adopt a unified national health system, supported by taxes and providing a basic, but limited, system of health care to all our citizens. The President doesn't plan to propose such a single payer plan just yet, but his proposal to let everyone buy into a Medicare-like program will get us there soon.

This next year should be very interesting.
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