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Commentary: Real health care reform will have to come from the states

Oct 6, 2018 | Blog | 0 comments

The poor quality and inefficiency of American health care business as usual is wasting $1 trillion per year.

By Joseph Q. Jarvis | For The Salt Lake Tribune
Published: 4/23/2018

Yet again Americans have signaled that health care is at the top of the electorate’s agenda, according to a new HuffPost/YouGov poll.

Cost is our principle health care problem, yet elected officials repeatedly offer “reforms” that increase American health care costs, which already are twice as high as the average per-person cost in all other First World countries. All of the federal debt now and on into the future is due to unsustainable and unfunded health care costs.

We have high health care cost because American health financing (the private, for-profit health insurance business model) is incredibly inefficient, with overheads routinely at 25 percent, and because we have a poor quality health care system.

Poor quality care comes in three basic categories: clinically inappropriate care (including, but not limited to, defensive medicine), preventable injury to hospitalized patients (the fifth leading cause of death in the U.S.) and failing to do best practice care consistently. Taken together, the poor quality and inefficiency of American health care business as usual is wasting $1 trillion per year.

Real sustainable reform must change the way we do health care business. Congress is manifestly not up to that reform. Congress, however, may be able to agree to allow states to attempt sustainable health system reform.

Hidden within the Affordable Care Act was a section (1332 State Innovation Waivers) which would have allowed states some leeway in attacking health care delivery problems. Rep. Pramila Jayapal, D-Wash., is preparing legislation that would strengthen the power of states to reform health care systems, and even allow neighboring states to band together to achieve better regional health care delivery. The proposed bill, entitled “The State-Based Universal Health Care Act”, seems like it should naturally receive support from both parties.

During a televised debate with his opponents in the 2010 U.S. Senate race, Sen. Mike Lee stated that he would support federal legislation which would allow states wide latitude in health system reform, even if a state were to choose to enact a single-payer health system. Lee, therefore, should welcome Jayapal’s proposed legislation and sponsor an identical bill in the Senate. I believe that many Republicans would agree that state-based health system reform is a logical step within our constitutional form of government.

I urge all Utahns to carefully inquire of the various candidates for Congress whether they will actively seek the enactment of “The State-Based Universal Health Care Act.” Only those candidates who agree to do so will earn my vote.

Joseph Jarvis

Joseph Q. Jarvis, M.D., is the author of the soon-to-be released book “The Purple World: Healing the Harm in American Health Care.” He is a Salt Lake City public health physician and two-time Republican nominee for the Utah Legislature.

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