I wasn’t looking forward to reading yet another book promoting yet another idea to solve America’s broken healthcare system. But it’s my job, so I dove into We’ve Got You Covered: Rebooting American Health Care by Liran Einav and Amy Finkelstin.
I’m a convert now – mostly. The first half of the book is the best, and best written, description of what wrong with our “system” and how it got that way. I wish I could assign my students the first half of the book (but they’d probably read ahead.) The authors had me when they first acknowledge that healthcare/medical care is just a small part of people’s health – social, genetic, environmental, and other factors are far more important. Despite this, the vast majority of the money is devoted to medical care, so they address that “system”.
I learned a lot. I have dogeared over a dozen pages with examples to use with students and others. Our system is a patchwork of band aids, covering some diseases (breast cancer but not lung cancer), some providers (community health centers vs. private practices), and some populations (based on income, age, or where people live) at a dizzying variety of costs. The patches are often chosen for political reasons or highlighted by one patient’s issues that, rightfully, gets a lot of press (e.g., Ryan White, Katie Beckett). The patches leave out a lot of Americans, and not just the uninsured. It’s inefficient and America can do better.
The second half is devoted to the authors’ fairly specific proposed solution to automatically enroll everyone in universal “basic” care, with the ability to buy up. (I’m not a total convert, but I can see the appeal.) They base their idea on what has worked, and what hasn’t, in other countries, research on American experiments, and our unique US context. As economists, they explore the incentives and potential unintended consequences, being clear that we need to monitor for all the things we can’t foresee now. (I especially love that part – health policy wonks confident enough to acknowledge that.) They skirt around the political question of how to get it passed. But they make a good case, that everything looks impossible until we have no choice but to make it work. I shouldn’t have avoided reading it.