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A Huff and Puff on Health Care

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Why, oh why, is health care such an impossible, vexing public policy problem? Actually the answer is basically quite simple.

On the one hand, roughly 75 percent of the American people in poll after poll say they are reasonably satisfied with their health care and insurance.

On the other hand, and perversely, roughly 70 percent of the same American people in poll after poll say they support health care reform to 1) contain costs 2) cover everyone and 3) fix problems like portability and job loss, etc.

Taken together, those two statements sound like a status quo confronted by a threatening, but well intentioned, challenge of change that could easily end up spelling 'stalemate'.

Well, surprise, surprise--that seems to be what we have. But, hold on a moment, maybe we have simply been going through a complex political sorting-out process. And, once again, our new, young President, who has taken lumps throughout this affair, may turn out to have been exactly right to give the body politic time and space to work it out.

There are, of course, several significant nodes of opposition to the President's plan. One is people who want him to fail simply for the sake of injuring his whole presidency. Another is people who are simply gradualists and want to limit change to modest increments allegedly to avoid making newer, different, bigger problems, but really to protect the status quo. And a last group that doubts that cost containment can be achieved short of fundamental structural changes in the incentives underlying the present health care system, which are not addressed anywhere in the present plan.

At this moment the President's unarguable, and overwhelmingly valid, point must take over the rational debate because the status quo is simply untenable. In just a matter of years, the country truly risks bankruptcy if we fail to control health costs.

And that is where we are now.

And that is why it is time for the silent, but complacent, majority to assert its voice in crafting compromises in several of the sub-debates. For example, the "public option" debate is held out as risking socialism, which on its face really makes no sense at all because we already are there with Medicare. And, a major reason why there has been such broad acceptance of today's status quo is because on balance Medicare really works quite well, partly because its costs are not constrained. An additional, new public option governed by marketplace rules of efficiency with no permitted deficits should not be objectionable, particularly if Medicare's costs are also properly constrained.

On cost containment: there really are few arguments left about digitizing medicine; there begins to be common ground in the arena of tort reform and defensive medicine; and there really are few arguments left about conferring benefits on illegal immigrants except in serious emergencies. And virtually all the points about prior conditions, portability, job moves or loss, etc. have already effectively been resolved.

While we may not get a perfect bill that makes everyone happy, we can hope and expect to get a significant move forward so that in future years, we can hopefully address today's unaddressed problems of misdirected incentives throughout the whole culture of our health care systems. And if you think today's debate has been tough, wait for that one!