A Horse, a Mule...or Neither?

Jul 3, 2007, 12:56 PM, Posted by Al Shar

I’m confused! Last week I went to see Michael Moore’s Sicko (read Susan Brink’s excellent Los Angeles Times article) and came away thinking that he’s got the solution to the U.S. healthcare problem. It’s a single payer universal health care system. Then I read Vijay Goel’s response to my blog posting and learned that it’s a collection (from the patients) and efficiency (from third party payers) problem that direct payments to providers would solve. The week before I was out to dinner with a friend who was able to retire early and tried and failed to find an HSA that would include his doctors and medicines. Finally, I went out to dinner with a physician friend who’s now in her own boutique practice. She said that she’s finally giving the kind of care that she’s wanted to provide: immediate access, enough time to spend with and for her patients, enough free time. Before this she was looking forward to getting out of medical practice – she now says she never plans to stop.

I feel a bit like the rabbi in Fiddler on the Roof who states that both parties, one claiming that the animal was a horse, the other a mule, are both right. When told that that was impossible, he said that that’s right too. The fact is that we’ve created a very complex system of health care delivery that can’t/shouldn’t be sustained. We don’t yet have consensus for a solution, if one exists, or a collection of solutions that might coexist. Every possible solution has consequences that are potentially catastrophic but in espousing a particular direction the rules seem to be that consequences need to be ignored until after the argument has been decided.

It’s particularly American to think that some hero riding a big white horse will come to our aid and find the perfect solution just in the nick of time. I don’t think that’s likely to happen.

This commentary originally appeared on the RWJF Pioneering Ideas blog.