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Wednesday, August 26, 2009

The Politics of the Current Health Care Reform Debate

This post is a followup to Bret's earlier post.

Opposition to proposed changes to medical care/insurance programs has been growing and getting more and more vocal. Even though most people are at least somewhat satisfied with their circumstances they are willing to consider changes that make sense and don't seem fishy:
Yes, the current health care program does have problems. To fix them requires a series of repairs -- tort reform, portability, elimination of prior conditions as an impediment to insurance, and a safety net for people who don't have insurance or lose their jobs.

Health reform does not require a complete remaking of the system. If all that Obama wanted were to insure those who fall between the cracks, he could put them into the same wonderful program that Congress created for itself by subsidizing their premiums. This would neither require a thousand pages of legislation nor a new series of bureaucracies.

But building a new power base resulting from the mobilization of the political and economic periphery requires redefining the nation's health problems as the nation's health catastrophe.

Health reform is Chicago politics on a national level. Welcome to the city.

Also, when the president talks about competition he seems to mean something different than my notion of competition:
"Choice, competition, reducing costs — those are the things that I want to see accomplished in this health reform bill," President Obama told talk-show host Michael Smerconish last week.

Choice and competition would be good. They would indeed reduce costs. If only the president meant it. Or understood it.

In a free market, a business that is complacent about costs learns that its prices are too high when it sees lower-cost competitors winning over its customers. The market — actually, the consumer — holds businesses accountable and keeps them honest. No "public option" is needed.

So the hope for reducing medical costs indeed lies in competition and choice. Today competition is squelched by government regulation and privilege.

But Obama's so-called reforms would not create real competition and choice. They would prohibit it.

Competition is not a bunch of companies offering the same products and services in the same way. That sterile notion of competition assumes we already know all that there is to know.

Well-meaning politicians have created untold misery by assuming they and their experts know enough already.

The health care bills are perfect examples. If competition is a discovery process, the congressional bills would impose the opposite of competition. They would forbid real choice.

People who would be willing to make changes see all of this and the behavior of the political class and they are getting angry and losing trust:

Americans didn't vote for big government last November. They voted for a guy who looked like he could keep his cool in the heat of battle. If Obama wants to regain that cool, he needs to rein in the power-grabbers in Washington.

Actually they did vote for bigger government without intending to, but that's another subject. Here is how I would describe the growing opposition to any change at this time: they are calling a time-out on the political class until they start behaving in a trustworthy manner.

1 comment:

Hey Skipper said...

I didn't hear Pres Obama's speech last night, just NPR's coverage of it immediately afterward.

One thing struck me about what was not said about it: any mention of tort reform.

We should start with the easy stuff:

-- ensure portability

-- eliminate the tax advantage to employer provided health care

-- then eliminate employers from the picture entirely

-- subject medical malpractice claims to anonymous physician boards

-- eliminate state-line restrictions to purchasing health insurance

-- make purchasing health insurance mandatory, with a government defined minimum coverage standard.

-- For those who have at least that standard, deduct the 90th percentile cost from gross income.

-- For those that do not, increase their tax to make up the difference, and randomly assign them -- and the money they represent -- to health insurance companies.