Many of a progressive mindset such as Sen. Bernie Sanders often say that healthcare is a fundamental right, along with access to clean air, water, nutrition, and so on. While I agree with the premise that as a society we have a moral obligation to ensure every person can access healthcare, I disagree about how many progressive leaders have proposed to make this possible. A weakness of our political discourse (as I see it), is the tendency to view all problems in binary -- you either support democrats or republicans, and even if the two parties are similar in many ways, little discussion survives outside those two dueling parties.

Many progressives propose that a government-sponsored program is the solution to healthcare (and many other issues), while the conservatives constantly seek a so-called market-approach. Can there be no other alternatives? Certainly most people can look at the federal government budget and see that the ballooning costs of the existing government sponsored healthcare (Medicaid and Medicare) are unsustainable. Likewise, it is also apparent that the 'market-driven' health insurance companies who determine care and the for-profit medical industry are also not serving the interests of the public. Throwing even greater trust into either of these systems, neither of which works particularly well or is cost effective, seems foolish.

I am not an economist, healthcare professional, or expert on this matter of any kind (I teach and study science, mostly ecology), so I wouldn't put myself into the category of folks who should develop better solutions. I did read about an idea I liked very much, however, and that is Syndicalism--a system in which the organization is owned and operated by the workers. Costa Rica has had great success with improving their access to healthcare (25% coverage in 1990s compared with 94% coverage today, with improvements in quality of care while keeping costs low).

What if we followed the Costa Rican model with some modifications that allow for a much larger system? Costa Rica merged many healthcare agencies into one, giving those agencies more authority over financing decisions. Then they divided their country into coverage areas and assigned each citizen a primary health-care team, allowing providers track health trends and reducing costs.

What if in the US we had these coverage areas within each state, and local healthcare providers each bought into the agency for that area when they were hired. This might dissolve insurance companies and for-profit medical groups, but I see these entities as problematic anyhow. If each medical provider essentially owned part of the system they would have a financial incentive to ensure the best patient care for the lowest cost. If someone moved to a different coverage area, they would sell their shares and buy into the healthcare agency in the new area.

I could see US citizens frowning upon being 'assigned' a healthcare team, so while this could be done as a default, people would have to be given the option to choose a different team somehow. These teams, however, were key to the success in Costa Rica, and I believe they would be an improvement to the quality of care most receive in the U.S. as well. These teams would be interdisciplinary and able to provide preventative care (e.g. vaccinations, education), as well as acute and chronic medical support, drawing on expertise of all medical providers, pharmacists, data analysts, etc.

Finally, there would need to be an overarching (perhaps governmental) agency that studied quality of care and patient access in ongoing ways. An agency with a broad nation-wide scope could identify problems and solutions from different coverage areas as well as seek ways to improve the system in real time.

I believe finding some middle ground between for-profit companies and government run systems is important. As the UK found, government healthcare suffers at the whim of those allocating funding. I would hate for the capricious politics of our times to reduce the quality and access to healthcare for people in an entirely government-operated system. Likewise, the current system with for-profits driving costs to the moon is unsustainable and cruel. We can build better systems, we just need to get out of our binary way of thinking.

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