Sunday, November 08, 2009

Not waiting to "get it right"....

As the health care reform debate intensified, one strain of objection has centered on the "undue" speed and sloppiness of the reform effort.  We should slow down and get it right, opponents argue.

Only we have been trying to get it right for decades and meanwhile the problems have only gotten worse.  But they are right in saying the current legislative vehicles have enormous flaws and likely will not perform as advertised. 

Yeah, right - like any government program does.

So the choice is between ugly choices or none.  I go with ugly, and so does John Cassidy.
So what does it all add up to? The U.S. government is making a costly and open-ended commitment to help provide health coverage for the vast majority of its citizens. I support this commitment, and I think the federal government’s spending priorities should be altered to make it happen. But let’s not pretend that it isn’t a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won’t.
Many Democratic insiders know all this, or most of it. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration, like the Bush Administration before it (and many other Administrations before that) is creating a new entitlement program, which, once established, will be virtually impossible to rescind. At some point in the future, the fiscal consequences of the reform will have to be dealt with in a more meaningful way, but by then the principle of (near) universal coverage will be well established. Even a twenty-first-century Ronald Reagan will have great difficult overturning it.
That takes me back to where I began. Both in terms of the political calculus of the Democratic Party, and in terms of making the United States a more equitable society, expanding health-care coverage now and worrying later about its long-term consequences is an eminently defensible strategy. Putting on my amateur historian’s cap, I might even claim that some subterfuge is historically necessary to get great reforms enacted. But as an economics reporter and commentator, I feel obliged to put on my green eyeshade and count the dollars. [More]

We have used this act-first-and-figure-out-the-consequences-later practice as standard procedure for most of my adult life.  Our Iran policy springs to mind as an example. Congress - and the American polity, for that matter - have never produced brilliant legislative action as a result of careful study and reasonable debate.  Farmers ought to know that from many farm Bill experiences.

Perfection is the enemy of the possible, and I would sooner push the system to where, as in other developed countries, no American worries about getting basic health care, going broke because of a health problem, or losing health coverage when laid off.  We'll figure out how to pay for it and control costs when the economics absolutely force us to. 

This is how we do other less important programs, and how we arrange the economic crises that will allow for politically unpopular entitlement reform.


Brandon said...

So, would you plant a crop knowing full well it would be a disaster and lose money -Must act, but ugly?

Or would you rather fallow your land a year to mitigate the losses and try again later when the circumstances are more favorable? -Do nothing

To say since government always screws up, we ought to just let them screw up even more is stupid. ESPECIALLY since this is such a huge, expensive, unconstitutional freedom grab.

To do the same thing over and over expecting a different result each time is the definition of insanity.

John Phipps said...


The analogy of fallow is flawed, I would suggest. In fact, one of the biggest knocks on many reform ideas is they fail to "bend the curve", or slow the exponential growth of health expenses. Doing nothing for a year simply makes that problem worse. fallow ground improves with inactivity, our health cost problem worsens. That is doing the same thing over IMHO.

I have seen no serious arguments about unconstitutionality. I am content to place faith in our judicial system to stand guard over potential "freedom grabs".

Anonymous said...

The unconstitutional portion comes from the requirement by the government to force all citizens to be insured with a penalty if we are not.

Helen said...

How much waste can you tolerate? American health care is enormously wasteful, from the vast amount of time medics and hospital spend on paperwork and fighting insurers to the overkill in terms of testing and checking to forestalling lawsuits.
The real waste is human capital. People who cannot afford insurance but don't qualify for free health care don't get the care they need. Some die, many get by with untreated treatable problems when they could be making a contribution to the country.
– A Canadian restored to health more than once by modern medicine without a bill at the time I couldn't pay.

Steve Deibele said...

The Case For A National Health Care System

I support a version of national health care based upon (i) the underlying philosophies and (ii) the facts of our current system.

I believe that a successful, cost-efficient, highly-responsive, state-of-the-art health care system should basically cover the entire population, with very few or no exclusions. The health care system could most efficiently be run by LOCALLY-ACCOUNTABLE and TRANSPARENT government, not by private insurance companies. The system should address the whole of a person, including dental, vision, and mental health care. Preventive care should be emphasized.

Health Care Professionals and Institutions: The medical professionals should be rewarded not only for their treatment services to address illness and injury, but also for preventive treatments and for the excellence of health of their patients. A reform of malpractice liability is sorely needed for the healthcare professionals and institutions and should be part of any health care system reform.

Patients: The patients require very timely, responsive health care. The patients should be completely free to choose their medical professionals. The patients should be able to solicit second opinions for their treatment program. In all cases, the treatment decisions should be made together by the health care professional(s) and the patient, not by the insurance companies.

Health Care System Monies: I believe each individual, throughout his or her own lifetime, should basically provide his or her own projected healthcare monies. The basis of the health care system should be financed by regular payments from each working-age adult individual. These payments would be based upon population statistics. In addition, the health care system should also include a significant, but affordable, co-pay amount with an upper total limit per year. This co-pay would apply to treatments, medications, and hospital stays. Lastly, the individual health care monies should effectively provide numerous incentives for individuals to maintain their health. Equitable health care fee rates would be set by independent commissions.
Philosophy: Our modern society requires a LONG list of occupations in order to function. Workers in those occupations deserve wages and benefits that enable them to clothe, feed, house, and care for themselves and their families. These benefits necessarily include comprehensive health care.
In my opinion, the profit-driven corporate interests of the insurance companies are a major cause of the health care crisis in the US and are responsible for an overly heavy “administrative” burden on the health care costs. The general wage structure throughout America and the American tax structures (both currently disasters) require simultaneous and comprehensive reform alongside the health care system reform.
An American health care reform package in 2009 should lead to dramatic net LOWERED health care costs for the population. Reform plans that do not show lowered health care costs should be rejected. America spends about twice as much per person per year for health care as other developed nations but uses roughly the same health care procedures, medications, and technologies. With efficient management, US medical cost structures should fall in line with the other developed nations AND American health should IMPROVE to their levels. A successful health care program should also provide improved health for more than 1 of every 7 Americans and greater security and peace of mind for probably more than 8 of every 10 Americans.


Steve Deibele
Kiel, WI

Ol James said...

..Mr, Steve, if only Congress could put your proposal into such simple terms. But, alas, they have to legislate, over emphasize, protect their supporters> (lobbyist) and further complicate it with added amendments and the like. Don't think the paper makers will go out of business as long as Congress has legislation to present.. I have to yet understand why it takes a few trees worth of paper to Say something. The Declaration of Independence just took one good sized sheet.