Monday, August 24, 2009

Some Thoughts on "Health Care Reform"

I know I promised some enlargement upon the text I reproduced in these pages at the opening of this past week-end. That enlargement will come shortly.

At Present, my purpose it to try to organize my thoughts on the debate over Pres. Obama's proposed legislative and regulatrory reform of important parts of our health care system.

The very first thing that needs to be clarified is what, "health care reform" means, and what it does not. What the term means in the mouth of a given interlocutor is never perfectly clear, and may be misleading. The following might be helpful:
  • "Health Care" refers to at least two things: (1) insurance against the cost of obtaining medical goods and services - we generally call this "health insurance"; (2) medical goods and services themselves - we generally call this "medical care"; by way of example, Liberty Mutual, INA and Blue Cross/Blue Shield, inter alia, provide the former (1); doctors, nurses, hospitals and pharmaceutical companies, inter alia, provide the latter (2).
  • The President has discussed the possibility of a "government option" or a "public option" as part of his "health care" reform package. At present, the "government option" does not enjoy public confidence, in any form; there is a great deal of public diffidence regarding the more robust visions of what the "government option" might be.
Some of the representations of the "government option", which some opponents of the proposal have made, have either been crafted to allow people to believe, or have more or less directly suggested, that the "government option" would, in its most robust form, include direct provision of "health care" in the 2nd sense, i.e. would mean doctors in the employ of the federal government, providing care directly to citizens at government-owned and operated facilities using government-owned equipment and supplies, all at the texpayers' expense. This is a truly appalling vision. It is also inaccurate.The President's proposal, in its most robust form, seems to be a government-owned and operated insurance provider, i.e. a provider of "health care" in the 1st sense.

This proposal is extremely problematic on its own, and requires no distortion in order to inspire public ambivalence.
It therefore seems to this blogger that many people are against a measure the President has never proposed, while many others (and many of those who oppose the phantom proposal) have been denied the chance to give the highly problematic real proposal fully informed critical attention.

Broad Public Consensus for Limited Reform

There is broad consensus regarding both the need for some reform, and the urgency of the need. There is broad bi-partisan support in Congress for some basic reform of health insurance law and regulation. The support in Congress accurately reflects popular sentiment regarding the following issues: the need to pass laws making health insurance plans portable; the need to eliminate or at least severely restrict the ability of health insurance providers to refuse (or drastically alter the terms and conditions of) coverage based on pre-existing conditions.

These two measures are almost universally recognized as urgently needed - they are the "no-brainers" of the debate. The President could push hard for these measures, simultaneously announce a period of consideration and reflection on other parts of his reform package, and see the reduced-scope reform package pass with broad bi-partisan support in Congress.

He could declare victory, and with reason.

Next time, I will discuss some of the difficulties with the "government option" and the real political importance of the President's refusal to give a straight answer to the question of abortion coverage.


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