Yes, 'n' how many ears must one man have
Before he can hear people cry?
Yes, 'n' how many deaths will it take till he knows
That too many people have died?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.

"The American health care system is confronting a crisis," said a report from the Institute of Medicine recently. "The health care delivery system is incapable of meeting the present, let alone the future, needs of the American public."
A previous report from this agency estimated that eighteen thousand Americans died last year simply because they had no medical insurance. And the ranks of he uninsured are growing every year. Medicaid and Medicare, designed to provide universal coverage to the elderly and the indigent, succeeded in their tasks. But the years have brought progressive unfunding relative to need. Medicaid now pays about 40% of the real costs of care. Medicare is headed for the same slope.

The Magic Bullet suggested for escalating health care costs was said to be Managed Care. But the Managers not only did not constrain costs, they added to the costs by superimposing administrative expenses approaching 30%. And when they did not meet the profit expectations of their stockholders, they left. The HMO’s deserted the Medicaid and Medicare programs in droves.

The next approach taken by the insurance industry has been the “defined benefit”, meaning that people who can afford insurance will be given a choice of the coverage they will, or will not, have. In essence, people are asked to gamble with their lives and fortunes. Gamble that they will not need outpatient care during the coming year, or drug coverage, or psychiatric services. Or, with premium rates rising progressively, that they will be healthy this year. The impact is to shift even more costs to the consumer. The main burden, of course, is borne by those who have the poor fortune to get sick at the wrong time or in the wrong body part.

Now, the headlines tell us that the President and Congress are planning to reform Medicare. The approach is to be “competition”. The instrument will be the HMO. The controlling force will be the insurance industry.

It does not take much sense to know that we are headed for disaster. The costs of health care are growing as the components get more expensive and we can do more for the sick. The insurance offered is more expensive but covers less. The social net is eroding, and the nation is aging.

How can reasonable people propose such an unreasonable solution?

The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.