It’s official: there’s a health care crisis in America. When all of the major candidates for President spend time talking about it, you know some solution is just around the corner. But, tragically, most of the common wisdom on what the problem actually is and how to fix it is 180° off course.

To understand that this true, why this is true, and how we came to be here, we first need to make a critical—but often forgotten—distinction:

What we care about is access to health care, not access to health insurance.

We shouldn’t give two cents about access to health insurance, except as a means to health care. Listen carefully to what all the politicians actually say: nearly all of the verbiage about universal coverage, universal access, etc. is focused on access to health insurance. Why? Because that’s something that government can actually promise, unlike access to health care. Short of enslaving all doctors, chaining them to desks, and scientifically distributing them around the country, there’s simply no way to ensure universal access to health care.

If you live in the middle of nowhere, for example, all the health insurance in the world does you no good if there aren’t any doctors for 500 miles. This is a problem in a surprising number of areas. In some regions the only neurosurgeons (for example) may be in large cities. The high cost of medical malpractice insurance has combined with natural market forces to increasingly limit specialists to lucrative big city markets. A growing problem in an age of increasingly effective but highly specialized medicine.

Or again, if the government’s brilliant solution to your lack of access to life-saving medicine reduces the available providers by capping what they can earn without capping their expenses (such as the aforementioned malpractice insurance), how exactly will that help you? What good does it do you to have every right to have some procedure only to find that no doctor is willing to perform it?

Or consider the dilemma for many in Canada. There, you have not only universal coverage, but the “right” to free comprehensive care. Unfortunately, you have no right to decide just what “comprehensive care” might be for any given condition. So, in some cases, you will be told to take some pain killers, shut up, and wait to die. In others, your operation may be scheduled in weeks to months due to shortages of facilities or personnel. All the problems, in short, of the worst possible HMO with absolutely no independent legal recourse.

The sad truth is that universal health insurance coverage will not solve our problems. Nearly universal health insurance coverage already exists in our system. (In fact, it’s part of the problem.) Out of 300+ million people in the United States, under 30 million citizens lack health insurance. That’s a 90%+ coverage rate, but somehow I suspect we don’t have anything like a 90% satisfaction rate with health care. In part because all of that health insurance actually makes decently priced quality health care harder to get. If you ever want to verify that for yourself, shop around for doctors offering to pay in cash, off the system. You’ll be surprised at the deals you’ll find, especially for routine things like office visits—which account for the bulk of most people’s health needs.

If we’re really serious about providing quality health care to as many people as possible, for the best possible price, we need to leave aside the rhetoric and actually look seriously at the real problems. So I propose to do just that over the next few weeks, examining the problems of consumer health insurance, high drug costs, malpractice insurance, and health care for the poorest Americans. If you’ll join me, I think you’ll be surprised at some of what you find, and I hope you’ll come to agree with me that our focus needs to shift to what really matters: the best health care possible for the most people at a reasonable cost.

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