Reforming Health Care Responsibly (072309) by J. F. Kelly, Jr

A commentary by J. F. Kelly, Jr. Like so many other important issues, health care reform has become bogged down in partisan politics with liberals and conservatives again lining up on opposite sides. When that happens, each side digs in and focuses its energies, not so much on achieving compromise, as in defeating the opposition for political purposes and perceived future advantage. This is no way to deal with issues of such importance but it is, sadly, the way the ruling classes tend to deal with them. For intelligent debate to proceed constructively, it’s appropriate to first ask what we expect of government. For conservatives it’s generally less in the way of social services and more on defense and law and order. For liberals, the priorities are roughly reversed. It comes as no surprise to the reader that I consider myself conservative on most issues but I do believe that it’s reasonable to expect of government those services which we are unable to provide for ourselves or do without. I count protection from financial ruin as a result of catastrophic injury or illness or compounding medical expenses which can bankrupt a working or even a moderately affluent family as such a service. I believe it’s important to acknowledge that there is a problem with health care delivery in America and that it is urgent enough to require fixing. Unfortunately some ultra-conservatives are in a state of denial in this regard. We have in America the best health care in the world, they assert. Why tamper with it? Others contend that our health care system is broken. Costs are out of control and there are too many uninsured. They are both right. American health care is, arguably, the best in the world or at least among the best. But the delivery system is broken and costs are indeed out of control. It really matters little to a sick person or the parents of a sick person if America has the most superior health care service if, for whatever reason, that person or persons cannot access it or if in doing so they become ruined financially. We know this is happening and it would facilitate progress if both sides would acknowledge it as a starting point for reform. Can we agree further that costs are out of control? Medicare and Medicaid are going broke. Much of the cost is a result of malpractice liability protection. Families are losing medical coverage as a result of job loss or benefit curtailment. Those who say leave the current system, if it can be called a system, alone are invariably those who already have adequate, reliable insurance or can afford to self-insure. Something must be done for those who are falling through the cracks or are in danger of doing so. So the question becomes not whether to change but when and how to pay for it. Reform is overdue and President Barack Obama is right when he says that Washington needs a deadline in order to get anything done. That said, however, a final health care reform bill before Congress takes its summer recess is simply not realistic. The bill being debated at this writing by three committees consists of about 1,000 pages. How many of the 435 members of Congress, do you suppose, have even read it all, let alone fully absorbed its implications? How many pundits and so-called experts, not to mention ordinary Americans are familiar enough with its changing provisions to even render an informed opinion? Congress is not very good at this. Crafting laws is one thing but redesigning a system that accounts for over a sixth of the entire economy is quite another. Experts are needed and politicians and their staffs scarcely are expert at anything but seeking political advantage. Perhaps reform should be left to the individual states, copying from each other’s systems that seem to work. Massachusetts already has a plan in place. Connecticut just approved one, expressing pessimism that Congress will ever get around to dealing with this mess, just as they have dragged their feet on social security, illegal immigration and other needed reforms. Then again, the prospect of fifty different health care systems is not especially appealing. Federal reform is needed. But so polarized is Washington now that each side seems focused mainly on inflicting defeat on the other. Many conservative Republicans are now determined to defeat anything this administration produces. They see defeat of a Democratic health care initiative as key to derailing Obama’s entire domestic agenda. Democrats like Rahm Emmanuel, who said no crisis should be wasted in promoting a political agenda, believes that something—anything—must be passed while the window of opportunity is still open and before people get a chance learn more about the plan’s shortcomings and consequences. Mr. Obama seems to agree. Both approaches are shameful. The health care debate should rise above politics. If Republicans go all out to defeat Obama on this issue without offering an alternative, then they should be held accountable by voters for ignoring a valid problem for the sake of politics. If Mr. Obama and his allies ram a defective bill through just to get something passed and to score a political victory, they will richly deserve the wrath of the voters when the defects and costs are inevitably realized. Let’s at least agree that reform is needed and focus on how to make it as affordable as possible. Part of that cost should be borne by every American, one way or another, perhaps as a percentage of income from any source. It won’t be cheap, but we shouldn’t expect it be. Life is precious, after all, and we should spare no reasonable expense in safeguarding it. That’s mostly what governments are for. Copyright 2009 by J. F. Kelly, Jr.