Wednesday, November 25, 2009

Health Care's Failure of Imagination

So I guess I've degenerated. I now mostly am viewing the health care debate in Congress through primarily partisan lenses. I am rooting for Democratic failure. I have fallen in for the point of view that Michael Gerson pointed out some time ago, that legislation like this would fundamentally shift political discourse in the country and put conservatives on the unpopular defensive indefinitely.

However, I've been trying to mull over the ethical elements of what the nation's leaders are deliberating. A New York Times columnist recently wrote of how the health care debate essentially is a struggle between quality and vitality in our society as well as a tug of war between the young and the old. His was a helpful perspective. Also, I'm looking for a columnist to articulate another struggle implicit in the health debate: namely that major reform like this can come at greatest cost to those who have been playing by the rules and who have genuinely benefited from a combination of effort, family legacy, aptitude, and luck. The greatest benefit is enjoyed by those who have lacked one of those factors in some abundant degree. Unaffected are the exploitative.

I guess what baffles me most is the cumbersome quasi-solution the Democrats are pushing. The goal of extending coverage to Americans who don't have it is laudable. The legislation won't even get coverage to all Americans, however. Further, the solution proposed is typical New Deal / Great Society Democrat boilerplate: fix a broken system by adding more elements, making the mechanism even more cumbersome and inefficient while bringing about mediocre gains. Further, special interest groups line up at the trough to benefit from the new legislation.

Therefore, my biggest objection to healthcare reform, setting aside my partisan lenses, is the complete lack of imagination with our system. Core problems aren't addressed, namely controlling the cost of medical coverage and making more explicit the costs of coverage to users. As long as medical care remains an opague rather than transparent system as far as costs are concerned, the costs will escalate.

A key question left unanswered: Is medical coverage a public good? If the answer is yes, then government needs to look at completely nationalizing it. If the answer is no, then a simpler set of new guidelines by which insurers must operate and consumers can find protection is all that is needed.

But why haven't we looked at models of somewhat similar industries (at least economically) for inspiration. Namely:

a) a board for governance of healthcare that resembles the local school districts we have in our nation - local, democratic, and able to boil down debate abstractions into tangible concepts for voters

b) the auto insurance industry and the concept of accident and catastrophe coverage vs. checkups and maintenence

c) the dental sector of healthcare where costs seem more reasonable and, most importantly, transparent; further, that sector is a model for client-friendly practices

Please, Congress, think outside the box rather than apply techniques that harken back to the 1960s or 1930s. Further, the opposition could advocate for the private sector by showing how the markets have solve similar problems.

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