By Donella Meadows

–May 5, 1994–

While our elected representatives tangle themselves in the health care debate, I go on paying $182 a month for $1500-deductible health insurance.

While my insurance company hires more lobbyists, it doesn’t return my phone calls.

While the Congress tries to devise a plan that will make the Republicans look bad and the Democrats good, or vice versa, the average per person health expenditure in the United States is $2868 a year. In Canada it is $1915, in Germany $1659, in Japan $1267, in the Netherlands $1360. Those countries all have infant mortality rates one-third lower than ours, and life expectancies two years higher.

The good news is that our elected representatives have gotten stuck. Liberals don’t know whether to go along with the Clinton half-loaf or to hold out for something that would actually be fair. Conservatives are pushing a dozen alternative ways of ensuring that the rich keep getting better health care than anyone else. Coalitions are forming and unforming so fast that nobody can be sure what, if anything, will pass.

The stuckness means that ordinary citizens — most of whom dropped out of the discussion when it descended into an incomprehensible babble about utilization management protocols — have a chance once again to be heard.

So what should we say?

Suppose that the president and Congress decided not only to go back to the drawing board, but to hand the drawing board to us. Suppose they appointed a panel of citizens (of various ages, all with recent experience of the present health system) and nurses and doctors (with various specialties but weighted toward general practice). You and I are appointees, of course. They say to us, “We’re going to lock you up and send in whatever food and facts you request. Don’t come out till you’ve designed a health care system you like.”

Assuming that ideologists of the left and the right are kept out of this group (that wouldn’t exclude either you or me, right?), my guess is that we would finish our job in about a week. Here are some of the things I bet we would agree on.

The system must be very, very simple. The average fifth-grader should be able to understand it.

The system must be available to everyone equally. When it comes to health, Americans should not be divided into economic classes. A social security or green card should be the badge of admission to any health practitioner.

Every patient should have the right to choose his or her practitioner and should have free and easy access to the information necessary to make a good choice.

Health care should have nothing to do with jobs. That complicates the life of the business community, it creates paperwork every time anyone changes employment, and it requires a separate system for the young, the old, and the unemployed. The decision to hire or be hired should be based on economic considerations, not health care considerations.

There should not be different health care systems in different states — again to minimize paperwork, and so health care doesn’t enter into decisions about where to live.

Doctors and nurses should not be seen as industrial raw material whose “productivity” is to be maximized. They shouldn’t be judged by their ability to generate revenue. They should have schedules that permit them to lead normal lives and to have caring, as opposed to economic, relationships with their patients.

The system should reward both patients and practitioners for good health practices and preventive maintenance.

The teeth, the eyesight, and the mind should be considered parts of the human body and their care should be covered.

It makes no difference whether health care costs are paid to the government and called taxes or paid to insurance companies and called premiums. What is important is that the money go to health care, not to bureaucracy, advertising, lobbying, litigating, stockholders, lush corporate offices, or exorbitant executive salaries. That means health care should not be a profit-making enterprise. It should be government-run, but firmly separated from the corruption of politics, operated transparently, and overseen by a watchdog board of citizens.

Doctors and their patients should have the right to decide what procedures are appropriate when and for whom. But with that right comes the responsibility for everyone to be informed about healthy living, the effects of addictive substances, sexually transmitted diseases, how to control fertility, living wills, organ donation. Surely there are ways to transmit this information clearly, compellingly, and without preaching.

You’d want to add to this list or modify it, but I bet it wouldn’t take us long to get it right. Then we’d look around for examples of health systems that satisfy our criteria. We’d find them in Canada, Germany, Japan, the Netherlands. They’re called “single-payer” systems. The single payer is the government. We’d study those systems, adopt what’s best in them, correct what’s worst, and come out with the best health care plan in the world.

So why wait for them to ask? In Washington they’re stuck. Sound off. Loudly. Often. No other decision our government makes this decade is going to affect you and me more than this one.

Copyright Sustainability Institute 1994