Feature articles by Emily Friedman and Deborah Chollet, PhD
Healthcare costs are rising, and more than 45 million Americans, including an estimated 20 million working middle class, have no health insurance. How could this happen in the richest country in the world? Isn’t this a moral as well as an economic issue? Clearly, the insurance crisis is a complex challenge that has political, financial, clinical, and ethical ramifications. The questions inherent in this dilemma are, Does every citizen have a right to healthcare, whether or not they can afford it? Whose responsibility is it to make sure this happens? And what is the appropriate role for the hospital?
Frontiers asked two leading experts in the field to provide us with their insights. Opening the dialog, Emily Friedman, a prominent health policy and ethics analyst in Chicago, provides a brief analysis of the history and politics of this issue—how we got to this critical point and why this problem continues to get worse—and proceeds to describe the dire ramifications for hospitals, should this trend continue. Deborah Chollet, PhD, a senior fellow at Mathematica Policy Research in Washington, DC, then presents a number of solutions being discussed to address this problem, including the pros and cons of each. Together, these two experts provide a comprehensive picture of one of the most complex and enduring problems of the current healthcare system.
Weighing in on this issue are three commentators, each providing a different perspective. Kevin Lofton, FACHE, president and CEO of Catholic Health Initiatives in Colorado, believes that universal health coverage may be the ultimate solution, although such a program of coverage is not on the table for now. He asks two fundamental questions: Is healthcare a basic right? If so, who will pay for it? Without insurance and without federal/state funding, the responsibility continues to fall to the hospitals. Phillip Robinson, FACHE, CEO of Bayshore Medical Center in Pasadena, Texas, sees the hybrid strategy as the most likely solution: cooperation between public and private coverage. He believes that given today’s economic realities, the responsibilities for the uninsured must be shared among hospitals, insurers, the government and individuals. Both of these commentators agree that a reduction in administrative costs, a focus on quality care, and the elimination of waste and inefficiencies currently existing in the healthcare system would go a long way toward curbing the rise of healthcare costs—one major factor feeding the growth of the uninsured.
Rick Curtis, president of the Institute for Health Policy Solutions in Washington, DC, reminds us that previous efforts to expand coverage have failed to create a vision that clearly shows what mutual and individual responsibilities are needed for all Americans to have affordable access to healthcare. He points out that more Americans might be motivated to support reforms that ensure broad participation if they understood in concrete terms how current healthcare policies are unfair to them and dysfunctional for the care system on which they rely. He believes that the country’s best hope lies in federally funded state demonstrations and provides some insights on how to make that work.