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Perspectives on the Healthcare Debate: How We Got Here and What's Politically Possible

Efforts in Congress to change the U.S. healthcare and health insurance systems have prompted much debate. KSMU’s Missy Shelton recently spoke with a political science professor about the issue and files this report.

Dr. Mark Rushefsky is a professor of political science at Missouri State University who teaches a class on health policy. We recently sat down to discuss some of the issues that come up in the healthcare debate.

Shelton: Dr. Rushefsky, I know you brought some interesting statistics with you on how much we spend on healthcare in the US.Rushefsky: From 2000-2008, employer-based health insurance premiums increased at a rate three times faster than wages. So while our wages up, our premiums went up. So even if we’re not paying all of the premiums, and we’re not, what could’ve been pay raises have gone into premiums and that’s a problem. We spend a lot of money on healthcare in this country. I’m not going to say we’re spending too much because I don’t think anyone knows what the right amount is but we know we’re spending a lot more than anybody else. We’re spending about 16.2% of gross domestic product, which is twice the average of other developed nations. When you add the fact that those nations have managed to cover everybody and we haven’t, it really says something about how we’ve spent our money.Shelton: Why is it so hard to make changes to the healthcare system?Rushefsky: For the most part, if you try comprehensive change and try it all at once, which is what the Clintons tried in 1993, that’s politically not going to be possible. As a political scientist, I’d say you move incrementally. You start attacking pieces of the issue and then you come back and try to attack more. For example, even President Obama’s rhetoric has changed over the year. He used to talk about healthcare reform and now it’s health insurance reform. Maybe we ought to decide at this point, “What is the most significant problem we have?” Is it the cost of healthcare to individuals, businesses and government? Is it the fact there’s a significant number of people who are not covered or are under covered? Maybe there are ways to do both of those at the same time but I think it would be very difficult politically to do.Shelton: As Congress tries to attack certain parts of the problem, you hear critics of certain proposals using the term “socialized medicine.” Help us understand what that really means.Rushefsky: The idea behind socialism is that government owns the means of production. In healthcare, that means government would own the hospitals, the people who provide the services, the doctors, the nurses would all be government employees. If you look at the industrialized nations, the only country that means that definition is England. If you look at what a lot of other countries have, you have government paying for it but not necessarily controlling it or owning the hospitals. Canada does not have socialized medicine. They socialized the payment and that’s a little bit different. In the United States, the best example of socialized medicine is veterans, the VA. While there are some people who would like to have socialized medicine, it’s probably a very small number. Those who’d like a single-payer system, which is the kind of thing a lot of these other industrialized countries have, is a larger percentage, but not 100% or even 50%. So there’s nobody really in Congress proposing, with a couple of exceptions and those aren’t going anyplace, anything that would be identified as socialized medicine.Shelton: How did we get to this point in the US with our healthcare system?Rushefsky: If we had sat down to design a healthcare system, we never would’ve come up with the system we have. It developed…I don’t want to say purely by accident but not by any sitting down and thinking of what is the best thing to do for the healthcare system as a whole…just tackling little things at a time. The tax deduction for employer-based healthcare was something that was a historical accident. It came about in World War II because employers couldn’t raise wages, prices and they wanted to attract employees. The way to do that was to give them healthcare benefits and the federal government said, “Ok. We’ll let you take it off your taxes.” Then in 1953, the IRS made it permanent. And so, it’s developed piece meal and that’s a large part of the reason it’s been so difficult to change.Shelton: I’ve been speaking with Dr. Mark Rushefsky to get some perspective on the healthcare debate, how we got here and how lawmakers might go about making changes.