Sunday, July 26, 2009

Health Care Reform Blues

With reform unlikely to happen before the August recess, the likelihood of reform becomes less clear. After swings in momentum both for and against reform over the past few months, it has been interesting to see how quickly some ideas have fallen away under pressure, and how others continue to be recycled and brought back to the fore. It seems likely that we will have some sort of "reform" at this point, in that a bill will likely be passed by both the House and the Senate and signed by Obama. The question is will there be any actual valuable reform to a problematic and burdensome system or will it merely push off necessary reforms for another decade or so.

I think one of the most interesting developments has been that the Republicans in both the House and the Senate have decided to drop developing their own bill, after promising to do so since the beginning of the reform effort. While I can understand the desire to focus all of their attention on the current resolution being discussed, it seems that they are only falling into the trap of being the "party of 'no'" label which has been wielded against them expertly during the current Congress.

I also think it is dangerous for the Republicans to place so much hope on the Blue Dog Democrats. While allies on some issues, they are, at the end of the day, still Democrats. They know they can only push so far before they overstep their power and incur undesirable repercussions (such as the bill being moved to the floor without a committee vote). The Blue Dogs may claim that they are the beacon of fiscal conservatives and small business, but there are many ways to allay their fears and still have a bill that will be faced with obstructionism by Republicans.

I am often surprised that the current bill, even in its most liberal versions, is itself a comprise; not necessarily a good one. Many Americans, rightly in my view, favor an even more robust public system than is currently written into any of the House or Senate versions of the bill being floated around. The high costs of care (as I have discussed in previous posts) are not simply due to the high-cost treatments or expenditure disparities. They are in large part due to the cost of "doing business" under a for-profit system of health care. One of the key advantages of a single-payer system is the sense of solidarity that it brings amongst those involved. When people are all paying into the same system, there is an acknowledgement that while some are paying more, it is often for the greater good.

One final point about perceptions of U.S. health care. It is often stated, without any support, that America has the best health care in the world and that people from other countries flock here due to long wait times elsewhere. However, both these characterizations are false; but more importantly, they indicate that the debate is simply focused on the wrong sets of issues. Even if the U.S. had the best health care in the world and people did come for care unavailable in their homelands, simply stated, the U.S. health care system is unsustainable. Right now our costs continue to rise much faster than either the economy or costs of living. As health care continues to eat up revenue, we will be forced to cut other programs to pay for the bloated and overpriced care we provide, while still having worse health outcomes (and worse quality of care, in many cases) than countries with cheaper, more sustainable systems. To pretend that the problem is only quality and access fails to address that it is the costs that will become increasingly prohibitive and untenable.

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