Testing Our Progress

We want quality, affordable health care for all, yes, but how do we know that we’re moving in the right direction? Given that this week is the 64th anniversary of the death and funeral of FDR, and recognizing how much our current national mixture of optimism and timidity in the face of economic uncertainty has many thinking of the New Deal and Roosevelt, it seems worth reflecting on what has often served as the unofficial credo of the progressive movement, from FDR’s second inaugural address:

The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.

I think about this line often when reading through all the different arguments as to why comprehensive reform should include this or shouldn’t include that, should help this interest group but shouldn’t help that, etc. For me, FDR's line has nothing to do with classes or tax brackets. It has to do with who has much in our health care system as it is, and who has too little.

“Those who have much” is easy to answer. In an off-year in 2008, the top pharmaceutical companies still made billions of dollars, with Johnson & Johnson, GlaxoSmith Kline and Novartis making in excess of $10 billion just in profits. The top insurance companies also did well, with UnitedHealth breaking into the top 100 companies because their profits increases 12% in two years, and Humana’s profits jumping an incredible 71%, largely on the backs of Medicare Advantage plans. This during a recession, mind you. Hospitals are dodgier – some have made some incredible profits, while some have lost a lot of money, meaning on average, hospitals are basically breaking even. Similarly, doctors in some specialties are making a tremendous amount of money, while primary care physicians in private practice are breaking even, or even losing money.

“Those who have too little” is also easy to answer. It’s the rest of us. Businesses, large and small, who are dealing with crushing costs that make them less competitive at home and abroad. Families and individuals, who have seen their share of health care costs go up, the aggregate cost of care go up, but the quality of care and the wages they have to pay for it flatline, and the percentage of businesses who give comprehensive benefits go down. State budgets for health care. The federal budget. Those with pre-existing conditions. Those with chronic diseases. Those who need long-term care. Those who live an accident or illness away from bankruptcy. What was said by an IBM executive is true for most of the United States when it comes to health care coverage: “What we buy is garbage.”

From Medicare Advantage, to negotiating rates for prescription drugs for Medicare, to money for comparative effectiveness research, to the competition offered by a public insurance option, to bringing meaningful reform to those who our system leaves behind, how do all the proposals floating around get us closer to making progress? Are we focusing on those who have too much or those who have too little?

(Photo credit: marc.benton on Flickr.)