By: Matthew Kukla, Ph.D.
Dear friends and family,
I just finished my PhD in Health Systems Financing, Economics and Policy and recently returned from working at the World Health Organization in Geneva. While my background focuses on the U.S. health care system, most of my work involves reforming health systems in other developed and developing countries. I essentially deal with (a) how institutional frameworks, governance, and political systems impact health care and (b) how health care dollars are collected, pooled, and redistributed / paid among the big three (insurance, individuals and medical providers). Because this is the primary goal of the Affordable Care Act (Obamacare) and given the tremendous amount of misinformation circulating about these issues, I have written a summary of (a) what our existing health care system looks like, notably the root causes of rising costs and the uninsured, (b) the true content of the Affordable Care Act, (c) what the ACA should have done differently, and (d) some additional insights into our health care system that you might find prevalent and interesting.
While I have much to learn over the course of my career, I want to ensure your confidence that this write-up is accurate and non-biased. My data comes from my own work and a range of sources including the World Bank, World Health Organization, top academic literature, and the best non-partisan policy think tanks (RAND, Commonwealth Fund, Health Affairs, Kaiser). I have also been critical of many liberal and conservative “talking points” as well as the ACA, while providing the most updated evidence where possible.
Interestingly, the U.S. health care system is not actually a system, but something that has been put together piecemeal over decades of policymaking. Our political system is built for incremental policymaking at best; thus health care reforms have built on one another only to fill in any existing gaps. Yet we have never stepped back, looked at the big picture and restructured the entire system to be coordinated, efficient or effective. It’s like continuing to put band-aids on a gushing wound, when what’s needed is surgery. Or it’s like having 40 workers operate an assembly line that’s meant for 15 people — instead of removing them and simplifying, we add more people to manage those 40. The system becomes increasingly layered, inefficient, ineffective, complex and stagnant. The following is a brief overview of what our existing health care system looks like as a result of this reform process. While there is no silver bullet or single change that will fix our health care system (despite what people tell you), overwhelming evidence from dozens of developed countries and the US suggests that the following factors account for the vast growth in our healthcare costs (18 percent of GDP vs. 8-13 percent in most other developed countries) and lack of health care coverage (19 percent of the population / 49 million vs. 1-2 percent in other countries).