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.