Should the Government be in the Business of Healthcare?

Should the Government be in the Business of Healthcare?

“Every adversity, every failure, every heartache carries with it the seed on an equal or greater benefit.”-Napoleon Hill

Make no mistake the American healthcare system is in crisis. In my opinion we are not working hard enough, fast enough, and certainly not innovatively enough to reform this ailing system.  The conversation needs to be elevated at a national level and some pervasive myths need to be dispelled.

The government is already in the business of healthcare, and has been for a long time…


    • 1798- Congress established the precursor of the Public Health Services


    • 1917- Public Health Service authorized to care for WWI veterans service-connected disabilities


    • 1933- The Federal Emergency Relief Administration provides some medical, dental, and nursing services for indigent populations


    • 1943- Emergency Maternity and Infancy Care is authorized, seeming to “to some to be a precedent that could ease the passage at war’s end of a health insurance system for the general public” (Corning)


    • 1956- The Dependent Medical Care Act is passed, establishing the precursor to TRICARE


    • 1965- Social Security amendments authorize Medicare and Medicaid programs


    • 1983- Social Security amendments usher in the DRG payment system


    • 1984- The Child Health Assistance Program requires states to expand their Medicaid programs to include more low-income pregnant women and children


    • 1985- EMTALA passes requiring hospitals to treat emergent cases regardless of ability to pay


    • 1996- HIPAA passes introducing new rules and requirements for hospital


    • 2003- Medicare Modernization Act initiating a series of major changes to Medicare, including a new drug benefit



Healthcare needs to get leaner…


According the Institute of Medicine Medical Waste Report, in 2009 $765 Billion of the $2.5 Trillion dollars spent on healthcare was wasteful:


    • $210 Billion in unnecessary services


    • $190 Billion in excessive administrative costs


    • $130 Billion inefficiently delivered services


    • $105 Billion because prices are too high


    • $75 Billion due to fraud


    • $55 Billion due to missed prevention opportunities(


Entrepreneurial Spirit is a key part of the solution…


The government is has co-evolved legislation as the healthcare industry has developed, denying that is counter-productive.  Should government be in the business of healthcare?  Personally I don’t know.  My personal preference leans to local and entrepreneurial solutions.  However, the cost of healthcare is at unsustainable levels.  Any time that happens it threatens accessibility and that is everyone’s concern because a nation’s health is interwoven.  My greatest hope would be that the system itself is reformed to better align with the value it promises…better health.  Political grandstanding, denying there is an issue, and mis-informing the public is so counterproductive.  It violates the entrepreneurial doctrine I hold so dear.  A belief that favors outcomes over lip-service.  The best free market solutions have always been birthed from a spirit of, ‘If there is a better way then let’s get busy creating it.’  Let’s get busy!


Acronym Key:


    • DRG- Diagnosis Related Group


    • EMTALA- Emergency Medical Treatment and Active Labor Act


    • HIPAA- Health Insurance Portability and Accountability Act



More Resources:



    • Centers of Medicare and Medicaid Services Key Milestones



    • IOM Medical Waste Report Brief


    • World Health Organization Assess the World’s Health System


Shawna Beese-Bjurstrom, RN, MBA lives in Spokane, WA with her family where she is an Executive/Business Coach.  She writes on issues such as healthcare strategy, operational excellence, communication, and leadership, read her blog.

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