by Mitch Kokai
Senior Political Analyst, John Locke Foundation
Working in American health-care policy imparts a keen sense of déjà vu. The conditions that plague our health-care system today not only have deep pre-existing roots, but have been accurately diagnosed before. But diagnosis does not ensure effective treatment. We continue to try the same failed prescriptions and leave alternative paths forsaken.
Consider four issues that have received sustained attention in past decades: developing and implementing guiding goals for health policy, reducing high costs, curtailing inequality in the provision of care, and maintaining the proper balance between public and private decision-making. All four persist as challenges today, but we have arguably not made much headway in resolving any of them. The Affordable Care Act (ACA) remains the law of the land and has expanded health-care coverage, primarily by increasing access to Medicaid. The ACA hasn’t exactly reduced costs, however: U.S. health-care spending continues to escalate, reaching $4.3 trillion in 2021 and nearing 20% of GDP. And despite the increase in care, U.S. life expectancy actually declined in 2020 and 2021 to its lowest level in nearly three decades. Meanwhile, the Covid-19 pandemic had a disproportionate impact on minorities, revealing that inequalities of care persist as we create new ways to measure them.
Neither political party has offered a convincing case regarding how to address these challenges, what the goals of health policy should be, or how much of the response should involve private or public control or resources. One occasionally hears a call for Medicare for all or repealing the ACA, and not much else. Although reducing health-care costs remains a priority for voters, health policy consistently ranks below strengthening the economy.
These recurring problems suggest that we may not need innovative ideas or new reforms in health policy as much as we need to reconsider and implement some older ones that were never tried.