Government Reform - Universal Coverage - Universal Bondage?

To hear conservatives tell it, government “overhaul” of health care, would enslave Americans to power-hungry elites in D.C.

Liberals see it differently. They say universal coverage would be a high water mark for the conscience of a compassionate people, would ward off national bankruptcy, and would bring to heel private sector greed.

As a pragmatist, I think both sides are over-reaching and over-reacting. We may not be able to afford the status quo, but we can’t afford proposed reforms either.

We need sensible incremental reforms – tort reforms, competitive reforms, and reforms that turn loose, rather than hamper the American genius for innovation and entrepreneurialism.

And, Yes, we need responsible government oversight, too.

But we do not need crushing costly mandates, political favoritism for selected politicians and unions, and feckless Medicare and Medicaid expansion that would drive doctors out of practice and limit public choices.

A January 15 blog by Matthew Holt “Thinking the Unthinkable – No Health Care Bill?" shows the debate’s dimensions.

Matthew is a gifted health care strategist. He founded The Health Care Blog in 2003. It has become the most influential policy wonk blog. He co-founded Health 2.0, whose members believe Health IT will revolutionize health care. Matthew is witty, amusing, irreverent, and a reform champion. He speaks with a silver tongue.

Here is his opening paragraph in The Health Blog two days ago,

“After a resounding Democratic Presidential election win, a terrible recession, and a bruising year of politics, it would be just like America that a crazy election result torpedoes the health care reform bill. It would be the first Republican Senator win in 43 years in Massachusetts, a state that’s bluer than blue, and the actual seat being elected on Tuesday hasn’t been won by a Republican since 1947! But it’s becoming more and more possible, and the latest polls are all over the map.”

Matthew believes the American health system itself is “crazy,” and a Democratic loss in Massachusetts that “torpedoes the health reform bill” would be an act of absolute insanity.

Here is my comment on his blog,

" Matthew, Your summary is a little overwrought,

You say,

‘To sum up: no bill means in 5–10 years a huge rise in uninsurance, no reform of the delivery system, and no prospect for a rationalization of health care spending. That will mean the collapse of large parts of the health care system in a spasmodic unplanned fashion.‘ "

I say,

“The American people seem to believe the current reform bill would raise premiums for the insured, mandate individuals and employers to march to the beat of the federal drummer, bankrupt state treasuries, ration rather than rationalize care, saddle their grandchildren with an unpayable debts, drive doctors out the system because of being unable to keep their practices open with low Medicare and Medicaid payments.”

Both of us, I suspect, are overwrought and are overplaying prospects of success or failure of the health reform bill. An effective, quality health system, American-style, lies somewhere in-between our beliefs.

The United States is a culture of unprecedented diversity in a vast continental nation. Ours is not an Either/Or society. We seek Multiple Options. We are fractionalized. We do not believe in uniformity of outcomes. We have different tastes and values. For better or worse, we are segmented and decentralized, and we believe in checks and balances against a command and control government.

I thought of ending this blog with a pithy verse.

But when I went to the rhyming dictionary and looked up “coverage,” the dictionary said, “No perfect rhymes were found.” Ditto for “bondage.” Is it possible there is no perfect system, governed from above, or generated from below, for all of the people all of the time?