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David Katz, M.D. Headshot

Health Reform, Hallelujah!

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Health care reform has passed, and I say: hallelujah! Well, not so fast.

Health reform had passed the Senate, and then had passed the House. Then, it needed to pass the Senate again, which it would have done, except that Ted Kennedy picked a bad time to die.

The good citizens of Massachusetts, either deriving a civics lesson from Monty Python's "and now for something completely different," or just playing a practical joke on the rest of us, gave the most liberal seat in the Senate to a conservative republican. This would be like white smoke from the Vatican, and "Habemos Papam!" alerting us that the Cardinals had elected Richard Dawkins pope. Apparently, the voters of Massachusetts really like revolution. Or is that evolution?

Anyway, since health care reform could no longer pass the had to pass the House again. It did, and the President signed it into law, sort of. Because it still had to pass the Senate again.

Which it did, but in the process, it unpassed the House, partly- so it had to re-pass the House, again. Which, last night, it once again did. So today, minus the flourish of the first round, the President will sign health care reform into law. Again.

This could have all happened on Ground Hog Day, and Bill Murray could be president. But absent that, I think we've squeezed as much fun out of the arcane machinations of our government as one could hope.

Those of us looking on- even those of us leaning left of center- must begrudgingly acknowledge that if this is how our government is supposed to function, the republicans calling for a smaller version of it have a point. Of course, the republicans telling us government is dysfunctional are the ones who threw every possible monkey wrench into this process, guaranteeing the dysfunction they like to advertise. Having proven the dysfunction, I suppose they might also prove that smaller government does, indeed, work better by all quitting- but I guess that wouldn't be the smaller government they had in mind.

So, they are staying in government- presumably to fight for smaller government, and to make sure that health care reform doesn't become the law of the land as easily as all that. Republicans are now promising to oppose this new law in every way possible, telling us for the foreseeable future what it wrecks, and what it fails to fix.

In the spirit of Newton, I am here to tell you what it fixes, and fails to wreck.

For starters, I don't think it wrecks the Constitution. Some 14 state attorneys general have decided that forcing people to buy health insurance may be unconstitutional, and plan to oppose the new reform in court.

I'm no constitutional scholar, but I humbly note that I am forced to buy car insurance. I haven't seen an irate group of attorneys general at the DMV. If our attorney general was ever at the DMV when I was there, he, too, was stuck in the wrong line, having just completed the wrong paperwork.

The rationale for car insurance, one the political right might embrace, is that with power, comes responsibility. We drive our cars on public roadways, interact in them with other cars, and are, indeed, obligated to take responsibility for the associated liabilities.

We likewise drive our bodies -and our health- out each day onto the byways of social interaction, where they, too, could run into something- such as influenza, a heart attack, or for that matter, a car. Since you will get treated acutely if your body is hit by a car, insuring both body and car is simply a way of guaranteeing you won't punt the bill to the rest of us. Again, that seems something the political right could have invented.

Allegedly, government-run health care will wreck everything. But, those making the charge also staunchly defend Medicare, which is the closest thing we have to government-run health care, and which outperforms private insurance on almost every metric. I hasten to note this is actually just government-run reimbursement; doctors do not work for Medicare, any more than they will work for the government under the new law.

Allegedly the new law imposes the costs of the newly enrolled on us all. Well, the costs of the uninsured are currently imposed on us all in the form of higher premiums. And into the bargain, the uninsured miss out on primary and preventive care, getting only less effective, more expensive crisis care. Reform can't wreck this, because it was in shambles before.

There is the charge that health care reform won't bring down the deficit or lower costs. I have neither a Nobel Prize in economics nor a crystal ball, so I'll just go with: neither would the absence of reform! Call this one a draw, at worst. But according to the Congressional Budget Office, reform wins.

Get beyond rhetoric and rant, and there is a whole lot that health reform doesn't wreck.

As for what it fixes: it would have saved the life of my cousin who died of melanoma at age 34. He was between jobs and uninsured when he first noticed the odd patch on his skin. He had it checked out when he was once again working and insured. But by then, it was too late.

It fixes your vulnerability, and mine. No matter how hard you work or how successful you are, all it would take under our former system for you to find yourself out in the cold in the company of 50 million others is a chronic disease and a change of jobs. Get diabetes, or cancer, or heart disease, and change jobs to a new employer that does not offer your prior insurance, and you, my friend, have a pre-existing condition, and are uninsurable.

Make that were, since health care reform has passed, repeatedly. So again I say: hallelujah!


Dr. David L. Katz;