Power Dynamics

A critical approach to health care reform suggests that for true structural changes to occur in the U.S. health care system, we must be willing to challenge the power dynamics underlying the current system—something that did not happen with passage of the ACA. Anyone interested in promoting such change can benefit from the experiences of other countries that have successfully done so. Germany’s example suggests that it is possible to have an effective and cost- efficient system even with many different insurers—although in Germany, all the insurers are nonprofit. Similarly, Canada’s history suggests that eliminating private insurers—major power holders in the current system—can reduce costs substan- tially by eliminating the costs of selling, advertising, and administering the various insurance plans. Eliminating private insurers also eliminates the costs that accrue when doctors, hospitals, and other health care providers must track and submit bills for each client to each insurance company.