Introduction:  Listening to all the debates, accounts and news about the Affordable Care Act took me back to my  book:  The Buck Stops Nowhere:  Why America’s Health Care Is All Dollars and No Sense, first published in 2001. In Chapter 4, I took a look at the politics, incentives and perverse incentives, and costs in our health care system.  The following is an updated version of that chapter.  For those of you who do not know me, I am not a health care professional–my degrees are actually in Japanese and comparative governments–I am trained to look at systems.  I have worked in health care most of my professional life largely as an interpreter of the system for a curious public.

This is a sweeping, overly simplified account of complex issues, but at least it outlines some of the historical battles over policy, politics and costs of health care reform.  And hopefully adds some perspective on what underlies the current fight over the Affordable Care Act. 

Chapter 4: Where We Went Wrong:  Health care as Creed, Greed and Compensation

 Our battle over national health insurance and health care reform has raged since the early 1900′s in various forms. We ran amuck on several fronts.

We made three basic mistakes.  First, the debate has always been ideological—single payer/government run/public option vs. private pay/voucher/marketplace. Neither side listens to  nor learns from each other.  Second, health care became an employee benefit and a part of employee compensation and “terms and conditions of employment.” And, finally, we never tied the public health system to the commercial/employer based insurance system. This means we left those who were not in employer-based insurance programs without any reliable and consistent safety net or affordable alternatives. Of our economic peers, we are the only country that does.    Continue reading →