In Search of Solidarity

It's still early in my trip, but my impression so far is that there are many similarities in the issues faced by both the German and U.S. healthcare systems, particularly when it comes to keeping people healthy instead of treating them when they are sick. With regards to America, I'm not optimistic about this changing anytime soon.  Just the other day I read an article profiling Mark Bertolini, CEO of Aetna, who said that the future of healthcare was "retail."  That might be a good idea if what we mostly care about are markets (and in fairness, Bertolini expressed some good ideas about disease prevention), but what we need to care about is investing in a healthy population.  

And that is where there is a big difference between the U.S. and Germany.  The Germans have their challenges but they approach them with a different philosophy, one that goes back to at least the time of Bismarck; even today the German statutory insurance companies are called "sickness funds," harking back to when Bismarck instituted a system in which people contributed a portion of their wages so that when they got sick, the funds would replace their earnings until they recovered. Over time, access to care became woven into the social fabric. Germans came to see their economy as a social market economy, that is, one that combines  capitalism with the belief that society should protect all its members from economic ruin and social distress. This belief is called solidarity, or Solidarität, and is a key concept of German society.  This concept has moved Germany toward a health system that is universal, affordable and accessible. While not ignoring costs, it doesn't make money the primary factor in deciding what treatments to offer.  And while not anti-business, it does not allow businesses to unduly influence decisions. (As just one example, pharmaceutical companies are prohibited from advertising their products in the media.)

The U.S. does not have Solidarität, but we do have guiding principles, a moral North Star, as former CMS administrator Don Berwick said.  To the extent that our decisions about healthcare reform, in all its aspects, are divorced from those principles, we will continue our stunted starts and stops and half-measure efforts that just plug holes instead of fixing the proverbial dam.


This is true of so many of the issues we are grappling with.  Look at climate change. Much of the effort around climate change has been "technocratic," that is, working to create the necessary technology to fix climate.  But we know all too well how far that has gotten us.  Finding solutions is not enough.  The United States has no shortage of very smart people who are adept at solving complex problems.  What we are missing is to care about the problem in the first place. President Obama just shared this same sentiment with regards to the events in Baltimore.  "If our society really wanted to solve the problem, it would," the president said.  "It's just that it would require everyone to say, 'This is important.'"

He is exactly right.  When that change takes place, solutions follow.  It's as true for healthcare as for any major issue.  Until we reach a critical mass of caring, healthcare reform will just be a grandiose version of take two aspirins and call me in the morning.