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Why health care is like a Rubik’s Cube


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Health care reform is, for all its intents and purposes, on its last legs. While the current reform plan may not make much headway, that doesn’t mean there aren’t other ideas out there. But it’s never going to be an all-in-one solution. Dr. Elisabeth Rosenthal is the editor in chief of Kaiser Health News and the author of “An American Sickness,” where she explains how we might revive health care in this country. Rosenthal spoke with Marketplace host Kai Ryssdal about the health care economy. An edited version of their conversation is below.

Kai Ryssdal: You are a physician. You’re a journalist, as well, of many years. You know where of you speak on this topic. Why, then, spend more time on it in this book figuring out how to let people take health care back?

Elisabeth Rosenthal: Well, because I think the system is really broken right now. I’ve done a lot of work in social media with my journalism, and I just keep hearing these stories that are so distressing to me. People feel like they’re victims, like there’s very little they can do. Like they’re kind of cogs in this big machine, and they’re mostly satisfied with their health care, but they can’t bear the cost anymore.

Ryssdal: Without getting too political, do you think a solution to the current state of American health care necessitates Congress and the White House doing something, either when Obamacare was coming or now that Paul Ryan and Donald Trump want to do something?

Rosenthal: Well, I think the all-or-nothing approach is kind of dangerous, as we’ve seen, because we felt we had one “all,” and then that went away, and now we’re trying to figure out another “all.” And the health care is kind of a Rubik’s Cube. It’s really hard to get it all at once. Beyond that, a lot happens in health care at the state level, at your local hospital level. So I think there’s a lot we can ask for without depending on Congress to kind of come in with one big quick fix, because, as we’ve seen, that ain’t gonna happen right now.

Ryssdal: OK, so how much can I actually do if, you know, prescription medications are $2,000 a month and I’m making $1,500 or whatever it is. I mean, there’s a certain financial reality here that can’t be overcome just by saying, “Eh, people need to do more for their own health care.”

Rosenthal: Right. And I think this narrative that we’re into now is people have to be better consumers of health care. It’s kind of a false narrative because, most of the time, hey, your doctor says you need a test or you need a prescription, and you can’t find the price of that anywhere before you buy it. That being said, there are things you can do to protect yourself in this system, which I think we just don’t feel entitled to do. If my doctor says to me, “Oh, you need a knee X-ray,” I’ll say, “Please direct me to the center that’s qualified, that does a good job, but that has the lowest price.”

Ryssdal: But then the doctor is going to say, “Yeah, no, I’m sorry Elizabeth, that’s not my job. You’re the consumer, you figure it out.” And I can see you throwing your hands up right now, because that’s what I would do.

Rosenthal: Well, I think that’s kind of a cop-out from doctors, having been one. And I think, you know, part of the asking is that if everyone asks, then it will be part of their job to know. Right? They’ll have to know it. We’re paying twice as much as most other developed countries without getting better results. And, you know, our current president is a deal maker. We’re getting a bad deal.

Ryssdal: I know I said I didn’t want to talk about the politicization of medicine too much when I talked about Obamacare and the current GOP plan. But, do you worry that medicine has become too politicized and that that is the barrier to change?

Rosenthal: Well, the first thing I worry about is that it’s become too commercialized. Before I talk about the politics, I think one of the things I’ve seen in my lifetime, and, you know, as you said, I was a physician or I am a physician. My dad was a physician. It’s the infusion into this caring profession of commercial values, so that so much of what happens to us when we get care is defined by the finances of it, rather than the caring and the science of it. And, you know, trying to get the commercial part out of it now is really, really tough. That’s part of why the politics is tough, right? Because, I mean, we see at the town halls now, as there’s the debate going back and forth between the people who favor the ACA and the new GOP plans. People just standing up and saying, “Hey, this isn’t working for me.” I mean, there are a lot of solutions that will work, and what we can’t keep doing is choosing none of them. 

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