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.
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.
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.
And, of course, not only do we spend more than any other country, our heath outcomes are worst than most developed countries.
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.
Your article makes a very insightful connection between the societal impact of the emergence of millennial thinking and the battle to change healthcare. There is little doubt that there needs to be change but anticipating how changes will affect a complex system is extremely difficult. There are always unintended consequences. For example, efforts to improve the work-life balance of physicians was intended to improve a physician’s well-being. While physicians (especially younger physicians) work much less than physicians did 20 years ago, reports of physician burnout are higher than ever. Similarly, reduced physician work hours (and revenue production) should have lowered physician incomes. But the growth of physician employment by healthcare organizations (and the shortage of physicians relative to demand) has enabled newly recruited physicians to demand high salaries that require hospitals to subsidize physician practices. Even private groups often demand some type of compensation from the hospital, such as to take ED call. One wonders how long this trend can continue as hospital admissions fall and revenues are under pressure. Unfortunately, given the debt levels of graduates of medical (and nursing) education and following the laws of supply and demand, lowering incomes will not attract more people to becoming healthcare providers.
ReplyDeleteThe point is that what appear to be reasonable requests for change in a complex system can have unanticipated results.
As you suggest, Millennials are likely to promote changes that increase demand for services. The problem is that increasing demand when there is a shortage of providers creates an unstable system. To provide more care for less cost, the first effort should be to promote organizational and technological changes that improves the productivity of healthcare providers (unlike current EMRs) and improves the reliability of care.