When Americans and their representatives speak of a better health care system, they mean more coverage for more people. When health economists speak of reform, they mean cutting spiraling costs by allotting care rationally, according to which care will do the most good for whom.
When Barack Obama speaks, he refers to the latter ideal. But nothing currently occurring in Congress in any way reflects this.
For example, outcome research makes clear which treatments are most effective. Reform means channeling Americans into these treatments. Americans will never accept that, and the bills before Congress explicitly forbid paying only for treatments proven to be effective. When Michael Moore wants to get Americans riled up about insurance companies, he describes a case of a person with a fatal disease who is being refused a monumentally expensive experimental treatment by an insurance company -- that always does it!
The idea that to provide unproven care at great cost will deprive many others of effective treatments is foreign to American minds. After all, for us, each life is precious, and we want to do everything we can try in order to save a life, even when we don't know whether what we are doing will succeed. How many movies are premised on distraught mothers finding a way for their child to receive an esoteric treatment for a rare childhood disease that stupid physicians, insurance companies, and HMOs refused to approve -- those craven fools!
Americans will always demand the most treatment, at any cost. For them, good health care means someone else -- insurance companies, employers, the government -- will pay for this. So any reforms that place responsibility for sound health care decision-making back on consumers will be repudiated. Incentives that support rational, cost-effective choices have been removed from all proposed legislation.
Conservatives Republicans most love the status quo. Thus Sean Hannity, Newt Gingrich, and Glenn Beck laud the American health care system as the best in the world, while Gingrich's consulting company advises big players how to cash in on health care reform proposals. And when leading Republican figures chime in about "rationing," they are rallying people against anyone with a good job, money, and health insurance paid for by someone else having to submit to care based on medical evidence.
But, here's the rub -- while liberals (like Moore) are the most vociferous critics of the health care system, they decry only limitations in coverage. Thus, all proposals being put forward are geared towards making sure that more people will receive more expensive care, not on curtailing costs or rationalizing care. And we will all follow this path while our system becomes more bloated and untenable (which is uniquely true for the American system already) until it bankrupts the entire country, as well as the individual states.
This is the worst aspect of the modern American version of untrammeled socialism-capitalism -- grab as much as you can without having to pay for it. And, oh, up until the moment this system irreparably implodes, it won't make us healthy.