The Only Way to Fix Healthcare Insurance in the U.S.

Posted June 27, 2017 in: #healthcare, #Obamacare, #Trump

Our system of government has been amazingly robust for hundreds of years, but it fails when you have these two conditions:

1. An issue is too complicated for the public to understand.

2. Big companies are willing to distort the system for profits.

That situation describes the healthcare debate going on in the United States right now. Our undersized brains can’t grasp all the nuances and implications of any particular healthcare plan. And when our brains are confused, we default to our biases (usually party loyalty) or to whatever metric is simple enough to understand. With healthcare, the one metric that matters is how many people will be covered compared to Obamacare. If the Republican plan covers more people, it will pass. If not, it will fail.

Sure, Republicans will argue that the CBO projections are inaccurate. They will argue that comparing a mandatory plan with an optional one is comparing apples to oranges. They will be right about all of that, but it is irrelevant to the outcome. People will look at the number of people covered and stop there. So any Republican bill that covers fewer people than Obamacare is dead on arrival. That’s where we are now. And we don’t have a system of government that can fix this situation.

But what we do have is an active citizenry and social media. That’s a better system for designing a healthcare system. I’ll describe one way to go about it.

Some of you are aware of Github, a company that lets software developers contribute bits of code that are made available to all other Github users. Github is a big deal, and software developers almost can’t live without it. Perhaps it is time to build a similar system for fixing health insurance in the U.S.

Imagine a website where any interested party can contribute suggestions for improving any individual element of healthcare in the United States, with a focus on lowering costs while improving outcomes. Perhaps you have an idea about lowering drug prices, and I have an idea about online doctors. We submit our ideas, and the Github-for-healthcare users gets to improve on them or ignore them. The system would allow users to rank the ideas. In time, citizens could develop multiple ideas for every element of healthcare. Citizen volunteers could eventually create up to three plans and present them to Congress for a vote.

I’ll get the ball rolling here by framing the problem as an innovation challenge, not a cost issue.

I think Congress can pass a bill that overspends in the short run so long as it comes with a plan (or path) to greater coverage than Obamacare. In my picture above, you see the growing gap between future health care costs and tax revenue. That growing gap can only be closed by some combination of innovation, cutting regulations, improving competition, and improving prevention. Let’s call that a “moon shot” challenge. We don’t know how to get there right now, but Americans are good at figuring out this sort of thing.

My suggestion for getting a healthcare bill passed is for Republicans to create a credible story for how they will cover more people than Obamacare, at a reasonable cost. And the best way to make that case is with visual persuasion, starting with this sort of simple graph and extending to images of startups that promise to lower medical costs.

At the moment, Paul Ryan and the Republicans are trying to sell their plan with facts, concepts, details, and logical arguments. That won’t work. You need an aspirational story about how to get to better coverage than Obamacare via American ingenuity. Everything else is just noise.

I don’t mind letting Congress take its best shot at improving healthcare. But realistically, they can’t. They are not the right form of government for this sort of complexity.

Perhaps citizens can do what congress could not.