ObamaCare Is Not "a Good Start." They Are Blowing an Opportunity to fix Health care.

Time for another reality check on health care reform (so-called). Previously, people wrote that "Anything is better than what we have now." We now know that is not true. Now people write, ObamaCare "is not perfect but at least it's a start." Regretfully, this is also not true, for two reasons.

No "Start" at all
All remarks made by anyone (me included) about the Healthcare Reform Bill are guesses. Congress is negotiating secretly and without the transparency that Candidate Obama promised. That is why the scroll illustration above shows so many things possibly crossed out. No one knows what they are doing to us.

Whatever is passed, two consequences are certain: there will be more government involvement in health care financing and there will be more bureaucracy. More money will be gobbled up by the waste in the middle (my new phrase; do you like it?)

People who want single payer to reduce health care costs are going to get exactly the opposite: more payers, more "waste in the middle," and even more of our GDP going to health care but not to patients. That is not any "start" that I want.

There is a modern Japanese aphorism that advises: Fix the problem not the blame. To start fixing our health care problems, we must identify root causes not culprits. We need to understand the reasons why money is wasted rather than point fingers at insurance adjusters or HIPAA enforcers - people simply doing their jobs. They are not the problem. The system is the problem. Look carefully at the "Ten Reasons for High Health care Costs." No individual or group is singled out for blame.

ObamaCare is not a "good start" because it addresses none of the root causes for the failures of our health care non-system. We desperately need reform but ObamaCare does not do it.

Cannot Fix Gradually (by little "starts")
Most people prefer baby steps, incremental change, a slow "start in the right direction." Sometimes, this is the proper approach, as when things are basically sound and one part of the system needs adjusting.

If the wheels of your car are out of alignment but the rest of the car runs well, just align the wheels. However, if the engine block is cracked; if you haven't changed the oil, ever; and if the vehicle is a Ford Pinto with the exploding gas tank, get a new one. The thing was designed wrong in the first place. You cannot repair it. You need to start from scratch with a different design, one that works instead of blowing up.

Health care is just such an irreparably "broken system." While there are some good parts and lots of well-meaning people, the fundamental design is flawed. It can neither support itself nor provide proper care for its customers: the populace. Most agree we need radical change but then shy away from doing what is necessary. To fix a broken system, you must work on the whole system, not one part.

To fix a system as contradictory and dysfunctional as health care, you need to replace it. If you prefer to call this "health care reform," so be it. As long as we are curing rather than palliating, I do not care what you call it.

You cannot "reform" (fix) health care by adjusting the financing or beefing up regulations. Effective reform means creating a new system based on a better design, founded on principles that the public agrees upon. Hillary's ClintonCare, Tom Daschle's Federal Health Board, and now ObamaCare all fly like lead balloons because they are imposed from above. The heart of any workable and publicly acceptable system must start at the ground level, not in the halls of power.

First we need an extended, all-media national dialogue, not violent, partisan town hall meetings in response to a Plan devised behind closed doors. Then we can develop a popular consensus about health care. Only then can we make a good "start" at fixing the broken system.

PS. The topic of discussion for our national dialogue should NOT be responding to a specific plan or proposal: Obama's, McCain's, a think tank's, or some self-styled expert. The topic should be what we want health care to do and why it is not doing that now: general agreement on diagnosis first and only then treatment.

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Comments

[seawolf77]

Grow up America. Only old people deserve government health care. Everyone else has to PAY!!!!!!!!!!!!!!!!

[DannyDanson]

We know the root causes of this healthcare related economic crisis, and the recent financial crisis, even the opposition to reform and the majority of opposition to progressive policy initiatives in general, MONEY! , ACCESS! and the STATUS QUO! Is the proposed plan perfect, absolutely not, does if offer us tools for containing some level of costs and a route to gaining the information necessary in the short required to devise workable long term solutions, it abosolutely does. The for-profit health insurance industry has no patriotic obligation to the betterment of this country and/or Americans in General, rather they are beholden to Reaganest fiscal gymnastics and all the political conjecture embodied by the notion of Supply Side Economics, and the Invisible hand reach around pick pocketing" of a market driven plutocracy charged with facilitating a healthy citizenry. The Government backed public plan or H.R. 676 DOES offers solutions, in regards to the public plan, a counterbalance to private profiteering, or in regards to H.R. 676, a new system to build to fit our needs, the public plan offers us the means to incentivize best-practices, and outcome driven medicine as practiced by conscious and innovative providers, while giving the private insurance sector an opportunity to get with the program under the threat of H.R. 676 which could eventually take the best aspects of Medicare and what we can learn from a public plan and apply them to a new national system.

[worldlyhick]

For moral and security reasons, health care needs to be available to all. This is going to require the kind of investments in education and health care infrastructure that would not be attractive to private companies. That is to say, this would be the proper role of government and the taxes that they collect.

The Health Care System shouldn't be a big profit machine, but a system in place for the good of the people, that is ALL the people. Private companies are never going to be anything but devices to squeeze a profit out of everyone, at every turn.

We need some basic security in society that will allow commerce, education and culture to go forward. These are not difficult concepts. Most of the rest of the world has figured it out by now, just not the USA.

[CalexenderJ]

There's a couple of points that you're missing. The first is the political reality. Take a look at the scroll you presented, all of the items crossed off were done as a compromise to get republican lawmakers on board, which they still aren't by the way. The logical conclusion is that it's the republicans goal to blow this opportunity to fix healthcare. It seems to me that they want a weak ineffectual bill to pass, that, as you mentioned, won't solve any problems, just so they can point to the legislation as an example of the democrats wanting to increase government for it's own sake. Secondly, we have to deal with the insurance lobby. You state we need wholesale changes, and I couldn't agree more, but the insurance industry is pouring millions of dollars into capital hill to keep the status quo. As long as pockets are being lined, republicans and democrats are going to do the bidding of the insurance industry. Thirdly about the dialogue, as we've seen with a topic this complex, it's all to easy to spread misinformation. While wholesale changes would be preferable to tinkering, Americans are resistant to large scale change, especially when there's an entire group of conservative pundits who are spreading flat out lies about euthanasia and death panels. When large changes are proposed, it's easy to say, "well how do we know this is going to work", it's the devil you know vs the devil you don't.

[BarryS]

every other 1st world country is wrong. even though they have better health, longer lives , half the cost, and everyone is covered. what am i missing?

oh yes, logic. Guys. stop saying everything is better here. that everything is invented here, that this is eden on earth. it's just not true any more, if in fact it ever was.

[winchestereast]

well, the Private Insurers will be sending Valentines to this columnist - WE KNOW HOW TO KEEP PEOPLE HEALTHY - ready access to primary care, preventive medicine, diet, exercise - ELECTRONIC MEDICAL RECORDs will be good for insurance companies and other system salesmen and installers - they'll contribute little to patient care - SINGLE PAYER can work, keep cost down , maintain quality - ask anyone on Medicare - we don't need a health care dialogue ad infinitum, ad nauseum to know that the agribusiness, with its government subsidies and endless media advertising, have sold us unhealthy fat and sugar laden easy, cheap food - our kids sit at computers and grow lard, not muscle - GET BACK INTO SCHOOLS WITH THE FOOD PYRAMID, healthy food, no soda machines, BRING BACK PHYSICAL EDUCATION 5 days a week - FUND PLAYGROUNDS, RECREATION PROGRAMS, ALL THE THINGS WE LOST WHEN REAGAN CUT TAXES FOR BILLIONAIRES - gangs rose directly in proportion to those cuts - we can save our kids minds and bodies -

[tompoe]

We had the dialogue, and Single Payer was decided with the vote last year. Why would you want to rehash ad infinitum something that everyone agreed to? Do you expect it to come out differently? Your steadfast refusal to acknowledge what 5 billion people have conclusively demonstrated, and 36 nations that provide superior health care for all their citizens proves means you just cannot be the doctor you say you are.