Sunday, October 11, 2009

Health Reform: It's Simple, Stupid, Not Complex

I’m red-faced with embarrassment.

I thought health reform was difficult because the health system was complex.

As explained in the New York Times, “The Health Care Sprawl,”

“Health care is a sprawling subject. It involves economics, politics, and philosophical and moral values. There are complex delivery systems and hard-to-explain concepts, like how spending $829 billion over 10 years and adding 29 billion people to health insurance rolls could save the government money in the long run. There are terms to keep straight – single payer vs. public option – lobbyists for special interests, and five separate comprehensive proposals under consideration in Congress, running to thousands of pages.”

And I explained in my book Obama, Doctors, and Health Reform, on why complexity poses one of the main obstacles to health reform,

“American health care is a whirling Rubik’s Cube, with millions of interrelated moving parts, institutions, and people, each with agendas, axes to grind, and oxen to gore.”

But in the end, as I explained in my last blog, the difficulty with implementing reform is not all that complicated. It comes down to power politics.

One of the tenets of American Democracy is that the majority rules. Democrats, still frustrated over recent Republican controls over the Presidency and Congress, take that tenet seriously.

Democrats are like Humpty Dumpty. They are now sitting on the top of the wall, and they fear if they fall all the King’s horses and all the King’s men will not be able to put them together again.

Then there’s the question of who is in charge.

As Humpty Dumpty, speaking as a Democrat, might say of the word, “reform.” “When I use a word,” Democrats might say in rather a scornful tone, “it means just what we choose it to mean -- neither more nor less.”

“The question is,” would say Alice, speaking as a Republican, "whether you can make the word mean so many different things.”

“The question is,’ would Humpty Dumpty, “who is to be master - - that's all.”

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