Welcome, Comrade Patient

Capitalism is in big trouble, even in the U.S. and especially among millennials. So reports Fast Company and The New York Times. Even capitalism-friendly publications like The Wall Street Journal and Bloomberg warn about it.

The oft-cited reasons include problems like increasing income/wealthy inequity and dimmer outlook for good jobs, but I have to wonder how much of a role our health care system plays in these kinds of attitudes.

After all, in a health system driven by capitalism you’d like to think we’d be continually improving our health, getting more choice and convenience, and all at lower costs. None of that seems to describe how it is working in health care, which may help explain why more are becoming disillusioned with it.

The WSJ article cited a 2016 Harvard Institute of Politics survey, in which only 42% of younger Americans said they supported capitalism and only 19% identified themselves as capitalists. One student explained: “socialism has gotten less spooky; it’s no longer associated with communism the way it was. Straight-up capitalism has a lot of potential to be really corrupt.”

The 2017 version of the same survey found that two-thirds of those 18–29 are fearful about the future of our country, with only 14% believing we’re on the right track. No wonder; the World Economic Forum says millennials in the U.S., UK, and Japan are the first generation in recent history who are posed to be worse off than their parents.

The WSJ also showed a 2016 Gallop poll in which capitalism and socialism were rated equally favorably (both just over 50%) by respondents ages 18–29, which was a stark contrast to every other age group (support for capitalism goes up by age, while support for socialism declines). Similarly, a 2017 WSJ/NBC News survey found that the 18–29 age group was much more likely to say the government should do more to help people, again in contrast to other age groups.

People like economist Richard Wolff or sociologist Wolfgang Streeck suggest that perhaps capitalism is coming to an end. Professor Wolff thinks it may be replaced by worker cooperatives, but Dr. Streeck warns: “We’re going into a long period where we don’t know what is coming.”

That sounds like what our health care system may be facing.

In some ways, the U.S. health care system is a model of capitalism. Lots of people are making lots of money, whether they be stockholders in health companies, doctors and health care executives, or even supposedly non-profit parts of the system. The sector’s continued strong job growth is the envy of many other industries and the pride of many local communities.

The problem is, though, unless you are one of the lucky ones doing well with our current system — and maybe even then — you’re probably not too happy with it.

It costs too much, whether we look at the cost of care or the cost of the health insurance that is supposed to pay for that care. We get plenty of innovative new drugs and treatments, but at astronomical new prices. We see waves of consolidation, whose main effect seems to be reduced choices and higher costs. The data is too siloed. Healthcare professionals report dangerous levels of burnout.

And, of course, not only do we spend more than any other country, our heath outcomes are worst than most developed countries.

Last year, Senator Bernie Sanders made unexpected headway in his race to be the Democratic candidate for President despite — or perhaps because of — his socialist leanings. One of his key planks was for Medicare for all, an idea that has seen a strong resurgence generally. Even more popular is the (admittedly vague) push for single payor.

A Harvard-Harris poll found that 52% of Americans supported a single payor system, with even 35% of Republicans supporting. Young people were most supportive. Politico found that 49% of Americans support a single payor health care system, even more popular than adding a public option to compete with private health plans (44%).

The Kaiser Family Foundation tracking poll showed 53% supporting single payor, with similar support for both that and a Medicare-for-all approach. Pew Research Center found “only” 33% favored single payor, but noted that support is increasing quickly, and that almost half of those 18–29 support it.

Perhaps most astonishing is that a Merritt-Hawkins survey found that 56% of physicians now support single payor, a sharp reversal from prior surveys. 42% voiced strong support.

Now, Medicare-for-all isn’t single payor — not with about a third of Medicare beneficiaries enrolled in private, competing Medicare Advantage plans and with all Part D recipients in them — and even single payor does not mean nationalized health, like Britain’s National Heath Service. But these many survey results are warning signs that our current approach to financing health care is pushing an increasing number of people to call for something else.

Vermont actually passed single payor, but the plan floundered when taxpayers saw the cost. Colorado tried to pass single payor through an initiative, which down in resounding defeat. Yet keep in mind that we didn’t like the Affordable Care Act until it started to look like we might have it taken away, and then support grew.

The moral of the story may be that, when it comes to financing our health care, we don’t really know what we want, but we sure don’t really like what we have.

Right now, millennials are not as engaged in health care as older age groups because they tend to need it less. They don’t have as many health problems and don’t see health professionals as often. That’s why getting them to buy health insurance is a constant struggle, even when they have the lowest premiums.

But as this radicalized generation, who are already frustrated with economic inequity and the prospects for their future, realize how much they will have to pay for older Americans’ health needs as well as for their own, push will eventually come to shove.

We have some hard thinking to do about how we finance health care, and for whom. We have some hard thinking about what the role of profit, competition, and capitalism should be in our health care system. We have some hard thinking to do about why our health care system is not serving more of us better.

It may not be socialized medicine. It may not be single payor. It may not even be Medicare-for-all. But it for sure will not be what we have now.

Follow Kim on Medium and on Twitter (@kimbbellard)!

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