Privilege or a Right?

Everyone’s talking about health care these days – and for good reason.

First and foremost, there are the voluminous 2008U.S.presidential debates in many interesting formats in far-flung locales, as well as statements from the campaign trail from candidates in both parties.

Mitt Romney, for instance, is pushing his ability as a former Republican governor in heavily Democratic Massachusetts to pass a universal coverage plan, though recently he has distanced himself from the mandated-benefits approach taken by the Bay State and embraced his party’s free-market solution. Democratic frontrunner Hilary Clinton, whose failed attempt to expand coverage for all Americans when she headed up a task force on the issue as First Lady, was humbled into realizing incremental reform has a much better chance of winning support from the public and politicians alike.

Credit also goes to guerrilla documentary maker Michael Moore’s ever-amusing but serious indictment of the American health care system. His horror-genre inspired title, “SiCKO,” yielded rather anemic box office numbers – earning just $24 million in the U.S. versus $119 million for his previous outing, the incendiary “Fahrenheit 9/11”, which is the top-grossing documentary of all time that went on to earn $222 million worldwide. But at least “SiCKO” recently surpassed domestic numbers for “An Inconvenient Truth,” which must mean the U.S. electorate thinks finding affordable health insurance coverage for all its citizens is more important than combating global warming.

Be that as it may, I can’t help but thankfully think consensus is finally building that something needs to be done. When leaders from Big Business and Big Labor hold a press conference calling for universal health care in hopes of removing nearly 47 million Americans off the uninsured rolls, we know the issue has some major traction.

The trick, of course, is agreeing on an approach. Democrats usually favor taxes. Republications usually tax credits. But at least members of both parties, including President Bush, have found agreement for the need to end what they consider corporate welfare in the form of tax credits for employer-provided group health plans – an issue I’ve written about in human resource trade magazines for nearly 20 years.

My own sense is that given the enormous competitive pressures that are an inherent part of an increasingly global economy, captains of industry, union bosses, operations executives, financial and HR professionals all essentially want the same thing: predictable health care costs following several consecutive years of double-digit premium hikes, whether the plans are fully insured or self-insured. Their mounting frustration bodes well for the prospect of compromise, though how exactly that might look is hard to say since the financing and delivery of health care is one of the most complex public policy challenges facing the nation.

Perhaps at the core of any argument before we move forward is a simple philosophic point of discussion: is health care a right or a privilege?

My own feeling is that we should embrace the former and not the latter. And here’s why: a national obesity epidemic in this country (two-thirds of the population is considered overweight), coupled with a sedentary lifestyle for many Americans, means too many people are prone to developing diabetes, heart disease, hypertension and other co-morbidity factors that also could include depression. Moreover, there was some alarming research recently that suggested future generations could see their lifespan decrease if the status quo is allowed to continue for much longer. Our quality of life is eroding.

We’re all going to pay for the treatment of high-risk populations in some way shape or form. It makes perfect sense from an actuarial point of view to evenly spread any insurance risk among the uninsured, or growing underinsured, segments of the U.S.population who must manage chronic conditions on a daily basis with maintenance drugs in conjunction with a healthier diet and exercise. So it’s in our best interest to act on this problem before it becomes an even bigger headache for lawmakers, policymakers, insurers, employers, physicians and patients.

We also need to pay physicians and nurses based on patient outcomes as opposed to patient volume – the most perverse system I can think of – as well as encourage people to take more responsibility for their health. That means making healthier decisions about food and exercise, as well as striking a better work-life balance for greater mental health and peace of mind. A big part of improving health care consumerism is to dismantle our junk-food culture by making more healthy choices available in fast-food restaurants, corporate cafeterias, vending machines and sidewalk kiosks. The other part of it is to encourage and reward people who join a gym, run, walk or bicycle around town.

To what extent the government becomes involved and we risk another bloated bureaucracy, or a private solution helps raise the bar on the competition for new ideas to solving this mess, is anyone’s guess. As I said, the issue is complex and there are clearly two schools of thought on how to deal with it. But clearly the time to act is now. Let’s hope and pray that political and business leaders are able to reach a consensus.