Saturday, November 21, 2009

Health Finance Ho-Hum

Today's Senate vote on the health finance bill leaves me completely ambivalent about the outcome. The massive lobbying, wholesale misinformation and political expediency have combined to produce legislation that that falls far short of universal access and meaningful cost control. The rough beast now slouching toward passage does nothing to reduce the overhead costs—profit and administration—of health care in the US. It adds complexity and perverse incentives to a system that already has plenty of both. The likely results offer little reason for enthusiasm.

What hope I do retain is that maybe this year’s legislation will be a step toward a better system. TR Reid, in Healing America, builds his model of the “best health care system in the world” on a unified system that leverages collective purchasing power bargaining. Something along those lines would be a considerable improvement over what is likely to emerge from Congress this year.

But that’s in the future. Maybe. For now all we have are HR 3962 and the blended Senate bill. Weak as these may be, they still face further compromise so that that final result may not differ greatly from the system that it will supposedly improve. It will certainly be no simpler, nor is it likely to relieve most Americans of the prospect of choosing between medical care and bankruptcy. Its lack of universal coverage leaves the costs of uncompensated care unresolved. This year’s effort leaves much to be desired.

Forty-plus years ago, Medicare was hailed as a first step toward universal care. Few would have predicted then that, well into the next century, America would have the most expensive and least effective health care model among developed nations. Yet, here we are, still waiting to take that next step, even with four decades’ experience with a single payer system that works. The performance of my congress and president do not give me much confidence that our political system can enact any truly effective reform that the moneyed classes do not like.

This is hardly a surprising conclusion. It’s not like this hasn’t happened before (health care ’93) or in other issues (perpetual war). Lack of surprise notwithstanding, I’m still disappointed. Maybe it’s because this kind of systemic failure shows how far America has moved from the idea of “the general Welfare” so prominently written into the US Constitution.

Reason enough to be disappointed.



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