Health care reform faces three demands and one constraint:
1) it must increase accessibility,
2) it must reduce costs,
3) it must maintain or improve quality, and
4) it must be politically viable.
By a careful and thorough review of available empirical evidence, comparing those countries that utilize universal single-payer health care to the United States, it is clear that the first three demands are most effectively met by the implementation of single-payer health care. This is the solution that the vast majority of economists, and The Economist magazine, favor. Just comparing Canada and the United States, Canada’s total and per capita costs are lower, coverage is universal, and the health care outcomes, by every statistical measure, are superior. But the fourth constraint makes this option currently difficult to achieve in the United States. Had we tried to pursue the best of all policy courses, the resistance to passing single-payer universal health care would have succeeded, once again, in undermining any effort at health care reform. We can continue to explore the possibility, at both the federal and the state levels, how best to move in the direction of the most efficient, fair, and effective health care system possible.
Given these parameters, I think that the recently enacted Affordable Health Care Act, though woefully imperfect, is a step in the right direction: We must not let the perfect be the enemy of the good. We needed to pass a bill that extends affordable coverage to more people and controls long term growth in health care costs without compromising the quality of care we receive. That is what we did.
Some on the left complain that it is too much of a boon to insurance companies, to which I respond: All successful and enduring historical reforms have acknowledged and negotiated existing distributions of power and influence. While it may be tempting to try to sweep away unjust, dysfunctional, and inefficient relics of the past, reform in complex societies with a huge historical accumulation of social institutional material involves working with what exists, sometimes dramatically altering it in the process. There is a surprising amount of sophistication and functionality in those relics, and a surprising amount of error in human conclusions about what would work better. All of this should be borne in mind when attempting large-scale reforms.
Some on the right complain that it is too much of a government take-over, a drift toward “socialism,” to which I respond: Government is our agent and tool for securing our right to “life, liberty, and the pursuit of happiness.” Using it effectively in this endeavor, understanding that complex modern market economies really do require complex regulatory architectures to function, and recognizing that our purpose in life is not to cling to slogans but rather to exercise our liberty in pursuit of sustainable, robust, and fair arrangements by which to co-exist, is no more or less than what reason dictates. Thomas Jefferson himself admonished us to “change with changing circumstances.” Government is not our enemy, and refusing to utilize it to perform functions for which it is uniquely best suited is not sound economic or fiscal policy. It is useful to remember that the exact same outcries were heard when social security, Medicare, and Medicaid were passed, all of which are now taken for granted as useful fixtures in our social institutional firmament.
While, in the absence of universal single-payer health care, I strongly favored inclusion of a public option, I never considered it indispensible to meaningful health care reform: A well-regulated market can conceivably offer enormous advances along all of the above-named dimensions (cost, coverage, quality, and, of course, political viability).
Though I believe we need a national health care policy, Colorado needs to pursue policies that complement and supplement reforms enacted by Congress. One vital role for the state is to improve our integration of existing institutions, such as schools, juvenile courts, and counseling services, to provide effective mental health screening and treatment for children who need it. There is considerable evidence that this would have significant positive impacts over time on educational achievement and crime reduction, as well as being cost effective in the long run.
More generally, I believe that we need to increase attention to preventative health care and to mental health care, making these ordinary rather than extraordinary parts of our lives.
