Since 2017, life expectancy in the United States has declined while increasing in many other developed countries. Experts have pointed to rising mortality among white male Americans without a college education from drug overdoses, alcohol-related liver disease, and suicide. Black men experience higher rates of some of these causes of death, although not with the recent increase as among white men
About 35 percent of U.S. health care spending is financed through commercial insurance, yet we spend more public money on health care than other nations. Still, more than 27 million Americans have no health insurance. Federal legislation is projected to cause another 10 to 12 million people to lose coverage.
Public opinion polls consistently show that a majority of Americans favor universal health coverage. The critical question is not simply whether everyone should have access to health care, but how such a system should be administered.
My Solution: An Independent Health Care Commission
I propose a national health care commission responsible for administering a basic health care program for every American. Such a task is beyond the capabilities of Congress and should not be controlled by the changing political leadership of the Department of Health and Human Services.
The commission could be modeled in part on the Federal Reserve: independent, as much as possible, from day-to-day political influence. It should be nonpartisan and include representatives from the medical professions, business, economics, public health, and the broader community, with geographic and demographic diversity.
Rather than “Medicare for all,” let us provide basic health care for all, with benefits guided by medical science and economic reality.
Controlling costs must be a central responsibility of the commission. For example, there might be significant co-payments for elective joint replacements, which are increasingly common as our population ages. Co-payments could be adjusted according to a patient’s ability to pay and the severity of the condition. Similar principles could apply to very expensive medications.
The commission could establish standards for innovative and expensive treatments whose benefits may be only marginally greater than those of less costly, well-established alternatives. It could study approaches such as England’s National Institute for Health and Care Excellence, which evaluates whether the clinical benefits of new treatments justify their costs.
New treatments should be carefully evaluated, including through clinical trials when appropriate, before becoming part of the basic benefits package. As costs decline and evidence of effectiveness grows, coverage could be expanded.
Americans who want care beyond the basic benefits offered by the program could purchase supplemental insurance or pay for additional services themselves.
An effective health care system should be a public benefit. Our current system distributes access and benefits unevenly while contributing to the growth of the national debt. Around the world, the United States is increasingly viewed as an example of how enormous health spending does not necessarily produce better health.
We need a health care system that makes Americans healthier, reduces poverty, strengthens economic security, limits the growth of our national debt, and improves our quality of life with a payment methodology that is not so distressingly complex.
The United States has the world’s strongest economy, leads in technological innovation, and possesses the most powerful military force on earth. Yet millions of Americans lack basic medical care.
For economic, humanitarian, and national-interest reasons, the United States can—and must—do better.
Bob Bilbro, had a career practicing internal medicine and cardiology in Raleigh, being a cofounder of Raleigh Medical Group. He has served as president of the medical staff at WakeMed and was president of the Wake County Medical Society.
