By The Bard of Wilmette from Eyesonobama.com:
Yesterday I passed a guy on the road. He was wearing a tee shirt with this message: "13.1 = half of nothing." I wondered, what does that mean? Oh, yeah, 13.1 miles is half a marathon, and the implication is that somebody who runs "only" half the distance of a marathon might as well have just stayed in bed. As one who has never run more than 3 miles at one time, I believe that anybody who can run 13 miles can claim a major personal achievement. Besides that, I also assume (with admittedly not much factual knowledge on the subject) that the health benefits to the individual are not significantly different, whether he/she runs 13 or 26 miles.
Yesterday I passed a guy on the road. He was wearing a tee shirt with this message: "13.1 = half of nothing." I wondered, what does that mean? Oh, yeah, 13.1 miles is half a marathon, and the implication is that somebody who runs "only" half the distance of a marathon might as well have just stayed in bed. As one who has never run more than 3 miles at one time, I believe that anybody who can run 13 miles can claim a major personal achievement. Besides that, I also assume (with admittedly not much factual knowledge on the subject) that the health benefits to the individual are not significantly different, whether he/she runs 13 or 26 miles.
I bring this up because the implied attitude of the guy in the tee shirt reminds me of the healthcare reform negotiations. This is the first meaningful opportunity to accomplish valuable healthcare reform in the U.S. in a long time. In the most recent previous opportunity – during the early part of the Clinton presidency – the Clintons had a decent chance, and they blew it. I say this not to pile on Bill and Hillary Clinton, but as a reminder that the Obama administration and its congressional allies should be careful not to repeat the mistakes made at that time. There is widespread agreement on the general need for healthcare reform, but also a lot of disagreement on the specifics regarding what can and should be done. The most important stumbling block is not Republican opposition to any proposed reforms, or that vested interests in the status quo give large contributions to certain members of Congress. The real barrier to healthcare reform is the seemingly irreconcilable differences between the leftists and the moderates within the Democratic Party. Both groups are interested in healthcare reform, but each of the two groups seems persuaded that only their own side’s proposals are worthy of support.
I realize that most people probably disagree with me, but I am with the moderates on this issue. In the first place, it is important to keep in mind what the goals of reform really are, and not confuse the means with the ends. In the second place, we cannot forget that politics is the art of the possible, rather than the forum for expressing supposedly ideal outcomes that have no realistic chance of becoming law. What are the real goals? They are:
* Universal access, or coming as close to it as possible.
* Coverage that cannot be denied or revoked due to individual health issues.
* Reduced healthcare costs, regardless of the payment sources.
I cannot think of any others. In a way, the first two points are variations on the same theme. We really just need a system where everybody, or nearly everybody, has access, and where the total costs can be reduced. Single payer, public insurance option, and similar ideas are not goals, but rather proposed means of achieving the goals listed above. I do not have much regard for the arguments that the drug or insurance companies are identified as malevolent factors that should be simply regarded as the enemy, which is the strongly implied message in some emails I receive. They may be part of the problem, but they are also part of the solution, if there is to be a solution. The qualifier about "coming as close as possible" to 100% coverage is also important. If 16% of the American people presently have no health insurance, and the only proposal with a realistic chance of passage by Congress would reduce the uninsured from 16% to 5%, is there not still a lot of value to such a plan? This could well be the situation we face. Opposition from the left in this case is the equivalent to saying that "13.1 = half of nothing."
A focus on universal access alone will not get any reform done. The concerns about the program’s costs are entirely legitimate. The program needs to be paid for, and simply increasing income taxes on the wealthy will not come close to paying for it. One fact that all sides of the healthcare debate can agree on is that the U.S. spends far more on healthcare – whether measured as a percentage of GDP or in proportion to the population – than the other rich countries do. At the same time, we get inferior results in terms of many measurements, such as average lifespan, compared with many other countries. No health insurance reform will be effective without our finding ways to reduce the total costs of healthcare. The ways to make this happen involve changing people’s incentives in the direction of lower cost behavior. These incentives include relatively non-controversial items such as emphasis on prevention, which is far less expensive than treatment after the patient is already sick. More controversial, but very valuable, is tort reform, which could largely eliminate the "need" for defensive medicine: tests and procedures that have little or no value in patient care, but which are done in order to protect against malpractice lawsuits. The presence of a small number of bad doctors, along with the possibility (however slight) of multi-million dollar jury awards for alleged malpractice, raises the operating costs for every doctor and hospital. It should be easier to get rid of bad doctors than it is at this time, and it is also reasonable to establish limits on non-economic damages to a plaintiff in a malpractice suit. Punitive damages should be limited to extreme cases and, even then, should not benefit the plaintiff or the plaintiff’s attorney. The purpose of punitive damages in a lawsuit is to dish out extra penalties to a defendant whose conduct was outrageously reckless, if not criminal. It should not be for the purpose of additional feathering the nest of the plaintiff and his/her attorney. The best form of punitive damage should be loss of license to practice medicine. The continued existence of litigation lottery keeps the total healthcare cost much higher than it needs to be, and with no incremental benefit to the society.
A small group of moderate Democrats and Republicans in the Senate has been working on a bipartisan health reform bill. What they come up with will almost certainly not be anybody’s idea of perfect, but it is likely to be a major step forward in improving the presently unsatisfactory situation. It also stands the best chance of actually getting enacted into law – IF the leftist wing of the Democratic Party can be brought around to accepting it. President Obama has got to show some leadership on this issue now. He was careful to avoid the Clintons’ mistake of crafting a huge piece of legislation and trying to force Congress to accept it, and of course the results then were disastrous. Instead, Obama has let Congress work out the details, but now that competing plans have come to the surface, Obama has got to make clear what he wants, and what he will do to achieve his own policy goals. My feeling is that Obama is sentimentally with the leftists, but as a practical politician, he should also realize that the leftists’ bills will not pass. Opposition to House committee bills is growing every day. It does not matter whether you or I think that opposition is deserved. It continues to build, and I am persuaded that those bills will never make it through. The bipartisan Senate effort has a real chance of success. Obama, along with Speaker Pelosi and her like-minded allies, may regard the bipartisan Senate proposal as a half measure, but it would still amount to a major accomplishment for Obama’s first year in office. Holding out for something they think is closer to the ideal answer will almost certainly result in getting nothing at all done. Obama’s political standing will be badly diminished, which would be a shame for many reasons. If that turns out to be the result, they should not blame the Republicans, the insurance companies, or any other supposed villains. Instead, they should look in the mirror, because that is where they will find the culprit.