Well, I've held off as long as I could possibly stand it, but I can remain silent no longer. What's happened with the "health care" reform debate is criminal. At this point, regardless of your perspective or point of view about insurance, health care, reimbursements, personal freedoms, rights and responsibilities, you should all be repulsed by what's happening. Why? Because we have a screwy system now that works for some and not for others, with lots of perverse disincentives, but nothing that's been presented so far as alternatives seems any better. Like democracy, it's the worst form of government except when compared to the others.
My main beef, however, is that no one has adequately described what the key problem is we are trying to solve, and prioritized solutions to the key problems. Is the problem that there are a number of people who'd like coverage but can't afford it? Yes, there are millions of uninsured, and some of them are actually people who need medical care and coverage but cannot afford it. Some of the "uninsured" are just crossing their fingers and opting out of insurance, hoping they won't get sick but are actually able to afford insurance. Some of the "uninsured" are between jobs, and need some bridging process (like COBRA) to get them from one plan to another. If the problem we want to solve is to ensure that everyone has access to medical care, regardless of their ability to pay for it, then fine, state that and solve THAT PROBLEM.
If the problem, on the other hand, is that medical cost inflation is out of control and threatens to devastate our federal budget in reasonably important programs like Medicare and Medicaid, even before we add new customers to the rolls, then let's find a way to hold down the cost of inflation and the cost of health care.
If, on the other hand, we are interested in reforming the insurance market, that's fine, but that's another kettle of fish altogether. And let's not conflate "coverage" with "insurance" - those are different things. Insurance is about protection against risk, and should allow rating and costs for pre-existing conditions and self-controlled issues like being overweight or smoking. And if portability is the issue, fine, let's let people band together in groups in their work worlds, or interest groups, or whatever, and buy individual or group coverage that's not tied to an employer.
The problem with the current situation is that we are trying to solve a number of integrated and mutually reinforcing problems simultaneously while ignoring the fact that achieving a satisfactory solution in one case (more coverage) by definition creates a bigger problem elsewhere (more costs). What's the most important issue? The expanding costs of medical care that threaten to wreck our budgets? Or the fact that a significant number of people don't have reasonable, cost-effective health care? Or that insurance isn't portable and thus locks people into jobs they'd prefer to change?
The House bill, as I have read it, and yes, I have read a good deal of the 1000 page monstrosity, tries to solve many of these challenges at the same time, really succeeding at none, and introduces a significant number of new "solutions" to problems that may or may not exist. There are sweetners in the bill for every constituency. If the bill were a meal, we'd have the surgeon general recommending we avoid it due to all the extra additives and preservatives.
When you go about "reforming" or changing an accepted but imperfect system that represents one-sixth of the GDP and is as important and personal as healthcare, have one or two clear objectives or problems to solve and address only those. This bill should be 20 pages long, not 1000. The reform effort is trying to do too much, too fast, with too little clarity and too little focus.
Don't get me wrong, this isn't a screed about the government. Businesses do this all the time as well. In any situation that's complex, where the existing situation is accepted but clearly less than optimal, it makes sense to eat the elephant a bite at a time, identifying the most important issues and problems and solving them first. Government does not own a monopoly in poor planning and execution in this case. In the example of health care reform, we just get to witness a poorly planned, defined and communicated change effort writ large.
Jeffrey,
I do not know how much research you have or have not done into the "supply side" health reform proposal's that are "out there." It may be that you have done extensive research and know exactly what you are talking about.
However, what I have noticed in listening to many voices is a tendency to dismiss the "supply side" proposals without giving them a completely unbiased and objective hearing.
Personally, I think that it should be possible to create a hybrid reform, but the congressional leadership is "bound and determined" to have it all their way.
By hybrid, I am not talking of a solution that starts out with a Democratic only proposal and then makes concessions, but rather selecting two proposals one from the supply siders and one from the "legislatives" and working to create a merger of the two into a single plan that would not destroy the medical market.
In spite of all the usage of words like "option" and "voluntary" - the cold hard fact is that within a quarter of a century or so, the medical community would cease to be a market based solution if the current Democratic proposals are made law.
Posted by: James Shewmaker | September 21, 2009 at 01:05 PM