11/02/2010 02:26 pm ET | Updated May 25, 2011

The Pledge to Repeal Health Care Reform Disqualifies Carly Fiorina and Others From Election to the Senate

There may be a lot of reasons to vote against Carly Fiorina as Senator of California. But one reason is obvious, even from 3000 miles away on the other coast. She says she would vote to repeal the new health care law.

Does she think the problems facing our health care system are not serious enough to require intervention?

Or does she recognize the need for reform, but opposes the particular choices embodied in the new law?

Either way, she shows she is not a serious enough candidate for these perilous times.

If it is the first reason, what is it about the U. S. health care system that she doesn't understand? We spend 6-7 percentage points more of our GDP on health care than the second most expensive country. That's a huge gap! Yet, all their citizens have insurance coverage, while 16-17 percent of Americans have none. Although we have some great health care professionals and state-of-the-art facilities, lots of studies- - over many years -- have shown the quality of medical care is unreliable. Even doctors, when they are patients, cannot count either on getting the care they need or on having it delivered well. Nor is any of this a secret. For decades, Americans have been telling surveyors that they are less satisfied with our system than citizens of virtually any other developed country are with theirs.

As a competitive person, if nothing else convinces her of the need for action, she should be moved by the fact that so many other countries produce more health care for more people and for less money than we do. By that measure alone, it is clear that our health care system is not serving us as well as it could or should.

But if, on the other hand, she does understand that our health system must improve and that government can play a role in helping it do so, then, why wouldn't she support the Patient Protection and Affordable Care Act (PPACA)? Not only would it expand the number of Americans with insurance, but at least half of them would obtain that coverage from private health insurance companies. As a champion of the private sector, she should applaud the dramatic expansion of the private insurance market.

Of course, that expansion comes with new strings, and maybe she doesn't like them. But they are designed to increase the chances that insurers actually serve their customers and the rest of the public. The fact is that, until provisions of the new law took effect in September, some private insurers made it difficult for many people to buy coverage. Among other things, they refused to cover people with pre-existing medical conditions and dropped people from coverage when they used services. Both of those actions are now against the law. Moreover, PPACA requires that insurers in the large-group market must spend at least 85% of their revenues on health care and those in the small-group and individual markets, at least 80%. In other words, the amount they can spend on employee compensation, shareholder dividends, underwriting, marketing, and other non-health-care activities is limited. Maybe Ms. Fiorina doesn't like these "intrusions" in the marketplace. Or maybe she doesn't like the public subsidies that would enable low- and moderate-income Americans to pay the premiums or cost-sharing amounts. Or maybe she doesn't like the fact that Medicaid will expand to absorb some people who can't afford to buy private coverage, even with subsidies. But if she doesn't like these provisions, what would she do differently?

The new PPACA is not perfect, by any means. There are surer ways to expand coverage, contain costs, and strengthen quality of care. But this is the version that attracted enough votes in the House and Senate to be enacted. Maybe she does not understand the legislative process well enough to know that even a perfect law -- assuming one could be defined and written -- would need to attract the votes of elected officials with different philosophical views on the role of government or with different susceptibility to the appeal of lobbyists and the contributions they can offer to re-election campaigns and other interests of the Congressmen and Senators.

Maybe I have overlooked other possible explanations, but on these grounds alone, it is hard to justify a vote for a woman who either has not learned that the health care system is unsustainable without reform or does not understand that the legislative process embodies the art of the possible, which usually turns out to be less than the ideal.

Politics may be messier than the view from the executive suite, but those who would play that game must know how to make it work to achieve progress. Carly Fiorina -- as well as others who would repeal the PPACA -- has shown she is not ready to take on that challenge.

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