Archive for March, 2010

Health Care Legislation

March 27, 2010

Health care legislation passed while I was in Canada on business. The subject did come up once. Those who lived their life in Canada were confused about how controversial it was, and that led to an intelligent discussion on the pros and cons of the reform – something that apparently is difficult, if not impossible, to achieve back here in the States. My Canadian co-worker referred to their system as “free” health care and my American co-worker and I pointed out that it isn’t free, it’s pre-paid. It’s pre-paid much like we pre-pay for a level of security provided by local police or the military. It is a matter of policy opinion whether health care should be prepaid or not, and that should have been the focus of national discourse. The Republicans purposefully avoided that discussion in favor of fear-mongering and the Democrats demonstrated their long-held incompetence at controlling the discussion. The media, looking for sensationalism, failed to increase the intellectual level of debate as well. We are left with a lot of misinformation, anger and fear on the topic. I am certain my perceptions of the bill aren’t entirely right, either.

First, I would like to talk about what the bill isn’t. The health care providers, for example hospitals and doctors, are in the private sector, so we didn’t socialize health care. The heath insurance industry is no less privatized than it was prior to the bill, so we don’t have anything approaching socialized health insurance, either.

The Office of Management and Budget (OMB) models suggest that it will be budget neutral or will slightly reduce the deficit. Of course, those are financial models based on assumptions – the same technique used by businesses to provide financial outlooks – and they could be wrong. However, the OMB is generally considered non-partisan. The OMB report is not “the big lie” as one of my conservative friends characterized it.  The OMB models for the Bush tax cuts were correct in modeling the large deficits they would produce. Where were the fiscal conservatives, then? The Republican argument that Democrats are the only party of fiscal irresponsibility were entirely dashed by the spendthrift Republicans in the decade past.

So it’s not socialized medicine. It’s not socialized heath care and it’s not a budget-buster. What is it, then?

The most important facet of the bill for me is the removal of exclusion for pre-existing conditions. That’s something that anyone – except for health insurance executives perhaps – should herald as a positive outcome.

It’s also an entitlement program in the sense that medical care will be provided for lower-income families. Republicans have a long history of opposing social safety nets and that is a position that is worthy of an intelligent policy discussion. That safety net, along with mandatory insurance, should significantly ease a serious dysfunction in our current health care system. People who can not afford health insurance often wait until they are very sick and then seek treatment in emergency rooms, which is a very expensive form of health care delivery, compared to doctor office treatments early in the disease process. This and the other systemic dysfunction in our health care system create the largest per capita cost in health care services for Americans, while leaving us 37th in health outcomes in the world. This, too, should be heralded as an improvement over the current situation.

I haven’t read the bill, of course. I am certain there are items with which I would disagree and items that I could add to the list of benefits. Instead of picking through reams of blogs and news articles to create a pros and cons list, I would like to close with an issue that is larger than the health care debate and is considerably more important.

Policy differences aside, I believe the most basic role of government is to first recognize problems and evaluate the scope of those problems. When a problem is recognized and the scope is appropriate for governmental action, our elected leaders should work together to create policy that strives for efficacy to resolve or ameliorate the problem. The gift of our democratic governmental structure to our society is the structure of checks-and-balances that encourages debate and pushes outcomes toward moderation. After the policies are put into play, there needs to be a governance model and checks for the efficacy in the field in order to adjustments as needed.

Republicans have lost the ability to recognize problems. The last Republican to do so was Ronald Reagan, who recognized the problem of an over reach of regulation and a tax structure that limited economic growth. He worked with Democrats in Congress and resolved that problem. The culmination of that solution subsequent to his presidency resulted in an over reach in the other direction and led to the economic failures of 2008. Today Republicans fail to see the problems in the current health care situation and most important, the demographic trends that were clearly unsustainable without action. Republicans fail to see the effects of global climate change. Republicans fail to see the effects of globalization on the middle class.  On the rare occasion where Republicans can not dismiss the reality of a problem, they are opposed to putting a governance model in place because that would imply a regulatory environment that enforces the policy, measures outcomes and supplies the information to make needed adjustments.  In spite of the economic failures 2008, caused by a lack regulation, there is no willingness by Republicans to put a governance model in place.  Simply put, Republicans don’t want to govern.

Democrats on the other hand seem to be able to recognize problems, but are ineffective at implementing policy. The financial system is still encumbered by the risks that led to the financial collapse in 2008. Climate change policy seems to be going nowhere. For what seemed to be the longest time, it appeared that Democrats – even with their man in the White House and majorities in both houses of Congress – were going to be ineffective at solving the problem of health care in this country. It is that effete nature of Democrats that prevents me from calling myself a Democrat.

While it is unclear if this health care reform will be effective, it shows that Democrats can still govern in spite of the recalcitrant and dysfunctional opposition party. That, at the very least, makes the health care bill – in the words of Joe Biden – a big fucking deal.