A Commentary on Bureaucracy and US Health Insurance Reform

“Vested interests can be relied upon to use their power, resources, and ingenuity to oppose change. Although the reformers have truth on their side, truth is just another special interest, and not a particularly powerful one. The villains willing to lie in order to defeat change have an advantage over those [people] constrained by honesty. Reformers do not have it easy.”- Paul Collier, The Bottom Billion

I’ve written a few blog entries critical of the inefficiencies of government bureaucracy here in Ethiopia, including my most recent saga about medicine runs. As a proponent and advocate for reform of the US health insurance system, I worry that my words can directly be used against this vital cause, at such a crucial time. So, against the advice of my trusty editor (and wife), I’ve chosen to use our blog for an opinionated commentary to argue a point of which I feel strongly. I hope to not offend…

Our blogs may bring up an important question: which is better—more government or less government? The answer, in my opinion, depends on how much government involvement already exists AND whether the institution being discussed requires a moral compass. I wouldn’t argue that the U.S. government should control pharmaceutical distribution. The free market is extremely efficient at getting medicines from point A to point B. And this activity does not determine who gets the medicines and who doesn’t. In Ethiopia, there are private wholesalers who are much more efficient in getting us our medicines than the government wholesaler. We’re usually in and out of their facility within 1 hour.

But…is the market well-equipped to make decisions about who can go to a doctor and who cannot? In the U.S., we have a health insurance system fraught with inefficiency, inequality, prejudice, and bureaucracy—a term mostly reserved for governments but needn’t be. More “efficiency” in this system is attained, for example, when an insurance company rids itself of its sickest patients. No one would knowingly allow a sick, needy neighbor to go without help, but somehow we can justify allowing that to happen to a stranger in our system. As a primary care physician, I was a frequent witness to patients being physically hurt by lack of or inadequate health insurance, despite working full-time jobs. Health insurance requires a moral compass in order to attain social justice. Are private insurance companies, whose primary goal is to make a profit for their shareholders, in the best position to ensure that health care is distributed fairly amongst the population? I think not.

It is intrinsically human, I believe, to see your point-of-view in what you read. Those of you who distrust the government will use my medicine run blog entry as proof that governments are doomed to be inefficient and will continue to criticize Obama for his efforts to reform our [broken] health care system. But I challenge you to consider the nuances of different scenarios and types of governments. From what I’ve gathered, Ethiopia is somewhat leftist. When I asked a highly-educated Ethiopian friend where they consider the U.S.’s politics to fall, he didn’t hesitate to say “right.” Who knows the accuracy of these beliefs, but in terms of pharmaceutical distribution in Ethiopia and health insurance in the U.S., I would argue that the two present quite unparallel scenarios.