US Healthcare Dilemma

McGuire and Anderson bring the findings of the behavioral biology of group cooperation to bear on the vexatious problem of healthcare reform. One of the few certainties that we have is that the approach of the last 50 years—arguments between advocates of government or private insurance—has led to intractable gridlock. It is thus necessary to ask whether the initial assumptions buried within this controversy might have fatal flaws. In the authors' views, they do. Our modern society would never tolerate funding of any other necessity or convenience by such clumsy methods. In short, McGuire and Anderson contend we must pay for healthcare the way we pay for food, housing, clothing, and transportation.

McGuire and Anderson begin by examining the flaws embedded in each side of the current debate. They offer ten postulates around which any successful system must be devised, and identify the problems from the perspective of patients, professionals, and public and private insurance providers. Finally, they apply the knowledge of the biology of human behavior to the problem of enhancing group cooperation toward a self-correcting system, which avoids the current major pitfalls. A workable system, they contend, will be one that is compatible with human nature; not a perfect system, but better than we have, and more likely to work than competing theoretical constructs.

MICHAEL T. McGUIRE is Professor of Psychiatry, UCLA School of Medicine, a member of the Brain Research Institute, and Director of the Sepulveda Veterans Administration/UCLA Nonhuman Primate Laboratory. He is the author or coauthor of more than 150 journal articles and four books, including Darwinian Psychiatry (1998) with Alfonso Troisi.

WILLIAM H. ANDERSON is Lecturer at the Harvard Medical School and Senior Psychiatrist, Massachusetts General Hospital. In addition to having held a variety of teaching and administrative positions, he is the author of more than 70 articles in scientific and policy journals.