Health ReformTunnel Vision and 2015

We don’t see the end of the tunnel, but I must say I don’t think it is darker than it was a year ago, and in some ways lighter.

John Fitzgerald Kennedy (1917-1963), at 1962 press conference

If we see a light at the end of the tunnel,

It’s the light of an oncoming train.

Robert Lowell (1917-1977), Since 1939

There are two ObamaCare visions for 2015.

Both view health reform as looking through a tube down a single national tunnel governed by and channeled through federal regulations.

The first sees light at the end of the tunnel. Its proponents foresee bipartisan solutions combining the best of the current health law with the best of market-based solutions. Under this scenario, the law will be patched up enough to satisfy the American public while placating the extreme wings of both political parties. Most people will be covered, the safety net will expand, government will set the rules, and Americans will have choice and affordable care without breaking the national bank.

The second also sees light at the end of the tunnel but the light is from on oncoming train. In this view, a head-on collision with a oncoming federal train is inevitable. A consequent massive train wreck looms. The economic and personal wreckage will be strewn over a broad economic landscape . Costs will be catastrophic . Fraud and abuse will consume 10% of entitlement outlays. Our descendents will never be able to pay down the national debt caused by subsidies for the uninsured and run-away health law costs, which will surely exceed $2 trillion over the next 10 years while crippling businesses and creating a socialistic straightjacket health reform state resulting in a redistribution of income and equal outcomes for all regardless of personal choice.

Both visions view health care train wreck as occurring in a railway tunnel with a one way set of tracks, as an either-or proposition requiring a national government solution.

There is another solution - the open roadway with multiple cars rather than a single train as the health care vehicles of choice. This solution would entail a state-by-state , market-by-market system with each state adapting to the needs of its population by creating its own path to health care equity with citizens of any given state being able to shop across state lines, as they know do for auto insurance.

Multiple states would communicate and compete with one another and would allow citizens to pick the health plan of their choice. There would, of course, be national road signs, e.g. , tax credits for people in every state, allowing all businesses to offer health savings accounts and choices of plans from across the country, catastrophic coverage, reasonable deductibles, no denial for pre-existing illnesses, and safety and quality sensible standards , there would be no individual or employer mandates for health care drivers.

Warning: there is no royal road to equity, and the road will not be strewn with flowers. There will be bumps and potholes along the way, all roads will not lead to Washington, some will end in state capitols and will require responsible drivers anda hands-off government. .