Star Wars fans among us might recognize that the general mood about the state of US healthcare system is about as gloomy as in the "Galaxy Far, Far Away" in the beginning of Lucas' original trilogy.

Which begs a question, where is "A New Hope"? Well, the recently unveiled Archimedes Movement might be just that.

I had a pleasure to listen to the man behind the movement at HIMSS this week. John Kitzhaber, MD, a former Oregon Governor starts with exposing the "status quo" as outlined in his position paper: "On the Road to Revolution: Fear and Loathing in the U.S. Health Care System". Here is how the Governor is stating the root cause of the system's woes:

Today we increasingly rely on public resources to finance the cost of care for individuals. In other words, we have created a system which focuses unlimited care and “benefit” one individual at a time while increasingly depending on public resources to finance the cost of that care.

So what is really in contention in the health care debate is the allocation of public resources and who benefits from that allocation. What people choose to do with their after tax dollars is their own business. What we do with public dollars, however, is everyone’s business.

To make the point he compares the healthcare system with the public education system, which for all its faults does have its priorities straight:

And all children, regardless of their economic circumstances, are eligible for publicly subsidized education, and all receive the same “benefit” which, in this case, is the educational experience offered by the primary and secondary school system. There is “universal coverage” for a “basic benefit,” or level of education. Nobody is left out. And the public pays for the same benefit for everyone.

However, parents who wish to give their children additional educational opportunities, a “richer benefit,” if you will, – a tutor, enrollment in a private school – can do so but the cost of these additional “benefits” is not subsidized by the general public. And, of course, this option is not available to everyone and is a function of disposable income. Families with few resources cannot afford a private school and must rely on the public system to educate their children.

So why is our healthcare system such a mess? Because the benefits are designed for special groups based on "categorical eligibility":

That is a far cry from our current health care system which was built not around a commitment to universal coverage but, rather, around the concept of categorical eligibility. That is, in order to be eligible for publicly financed health care you must fit into a category. These categories were established by Congress with the enactment of Medicare and Medicaid back in the mid-1960s.

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The gap exists because we have organized our system around categorical eligibility rather than around universal coverage and thus avoided answering the most fundamental of questions: who has the responsibility to pay for the health care needs of those who cannot afford to pay for it themselves? Instead we have, by default, left the economic market to answer the question for us.

But markets are designed to turn a profit, not to foster social responsibility so it should come as no surprise that no one competes for people who cannot pay. In fact, in today’s market-oriented terminology, people with a payment source are referred to as “market share” and we compete for them. Those who cannot pay are referred to as “liabilities” and, as you know, we seek to avoid them through adverse selection and cost shifting.

This is where ideological zealots, hell-bent on social engineering get intellectually dishonest to further their agendas and please their check-writing special interest bosses.

Liberal extremists would cry out for single-payor "solution" that would conveniently eliminate individual choice. Conservative extremists would pretend that there is no such thing as "social responsibilities" and throw everyone to fend for themselves in free market.

UPDATE: Note my definition of "extremist" as one who puts redistribution of political power ahead of improvement in nation's health, as the goal of a healthcare reform. There are the guilty and the innocent of this on both ends of the spectrum.

Workable solutions are never found on either extreme and Governor Kitzhaber understands that. His proposal is to design a universal coverage plan for Oregon and request a waiver from the Feds to implement it. Thus forcing a national debate in Congress:

We need to stop simply defending programs and start solving problems -- and the place to start is by approaching our health care system with the same eye to equity and sustainability with which we approach public education. If we did, we would have as our objective a healthy citizenry. To achieve that objective we would adopt an explicit policy of universal coverage for a defined basic benefit of effective health services subsidized with public resources.

All citizens, regardless of their economic circumstances, would contribute to the subsidy and all would be covered for the same basic benefit. Citizens who want access to health services not covered by the basic package would, of course, be free to purchase them -- but the cost of these additional benefits would not be subsidized by public resources.

Let me be clear. I am not talking about simply moving to a Canadian style single payer system – there are a variety of ways this can be accomplished, but the bottom line is this: we need to demand a different standard for that part of our health care system that is financed with public resources than for that portion that is financed with private resources.

Get ready for the sequel: "Empire Strikes Back". Special interests on both left and right will fight this plan. But the state of our health care system is so dire that they can hold their ground for only so long.

Join the revolution. Support the Archimedes Movement.