Originally published on August 20, 2009
I have to admit that this whole health care debate confuses me. I understand some of the main problems with the current system; things like non-portability of insurance across jobs and across states, the high incidence of medical malpractice lawsuits, the large numbers of people uninsured, and the rapidly rising costs. Clearly the current system has major problems and may be unsustainable in the long term. But what I can’t figure out by reading the popular press, listening to the pundits, or reading blogs is what is the central core of the health care reform proposal and how precisely does it solve these particular problems?
There are several reasons I think an answer to these basic questions are hard to come by.First, there isn’t one reform proposal out there.Different legislators have different plans and different ideas they hope to integrate into whatever becomes the final bill.As a result discussion of the issue gets distracted away from the core elements of the plan to its particular features … like the brouhaha about death panels for example.Or, the discussion becomes overly abstract, like, do we want socialism or not?
Another problem arises because of the way democratic reform works in our system. Any legislator who wishes to revamp the health care system may begin with a core plan and a simple structure to solve some of the major problems. However, as the legislation works its way through committees and is discussed among stakeholders (and bear in mind with health care reform, everyone is a stakeholder) amendments are made to the core legislation. First the powerful groups will weigh in. The insurance companies will suggests adjustments to the legislation to assuage their concerns and the changes will be added to appease that group. The American Medical Assn. representing physician interests will weigh in and propose changes and adjustments. The pharmaceutical companies will propose some changes and they will be included. Etcetera, etcetera, etcetera.
By the time a final bill is passed in committee and moved into the House or Senate, any simple plan that was originally proposed has now become a monster bill with so many pages and so many qualifications and special regulations that nobody – nobody at all – can understand the full ramifications.
This is one reason supporters begin speaking in platitudes. For example, President Obama said this week “What is truly scary—what is truly risky—is if we do nothing,”and “We can’t keep the system the way it is right now,”Since no one knows all of the specifics of the bill, not even the President, it is only really possible to talk about it in very general, one might say political, terms.
This is also why opponents search out and focus attention on the specific and suspicious minor clauses and raise these to the head of the debate.(like death panels)In any bill of monster proportions there will be plenty to object to and it is never hard to shine the spotlight on these and thereby cast doubt upon the entire proposal.
It is true that this is the way compromise works in a democracy.All interested parties have a chance to voice their concerns.Legislators weigh the importance of each argument, and amend the legislation whenever doing so pleases an important group.In the end every legislator cares primarily about making enough people happy so that they themselves can secure reelection in the future.That’s surely why the most influential groups are the one’s with the most money, who can, at least indirectly, influence the greatest future number of votes.
However, although the democratic system facilitates compromise of this sort, that doesn’t mean it generates an efficient or even a reasonable outcome. The main thing that concerns me is that complexity breeds inefficiency.The greater the number of special conditions and clauses here are in the bill, the harder it will be for system participants to figure it all out.That means health insurance companies, hospitals, pharmaceutical companies and others will all need to hire consultants and specialists to maneuver most effectively through the tangle of regulations.For well-educated professionals that will mean more jobs and higher salaries.But the more of these administrative jobs are needed to wade through the system, the more time and effort will be spent on that and the less time and effort will be spent delivering high quality healthcare.Or, if the amount of healthcare provided is maintainable, then the overall price tag will rise to pay for all of the extra administration.
So here’s what I’d like to see before supporting any kind of health policy reform. First I’d like to see a short, sweet and simple proposal; not one that’s thousands of pages long. Of course this is well nigh impossible since it would mean all the special interests would have to take out all their favorite clauses and the chances they would do that are virtually zero.
OK then, if this can’t be done then at least I’d like to see a proposal that is simple enough so that it can be explained to the average American.Someone, President Obama preferably, needs to be able to point to the different components of the bill and explain how and why it’s an effective means to solve the health care problems.How will it reduce costs … don’t just proclaim that it will?How will it solve the portability issue?How will it cover all Americans?Until at least this happens I think it’s far better if nothing is done at all.
