Tuesday, July 28, 2009

Health-care Reform and Congress

Pretty much everybody who believes that health care should be a human right, not a commercial commodity, and who makes a serious study of the abstract substance of the matter, concludes that the best solution would be (to borrow Obama’s words at the press conference) “what’s called a single-payer system, in which everybody is automatically covered.” But, by the same token, pretty much everybody who believes the same thing, and who makes a serious study of the concrete politics of the matter, concludes that a change so sudden and so wrenching—and so threatening to so many powerful interests—is beyond the capacities of our ramshackle political mechanisms. The American health-care system is bloated, wasteful, and cruel. Under the health-insurance-reform package now being bludgeoned into misshapen shape on Capitol Hill, it will still be bloated, wasteful, and cruel—but markedly less so. The House bill, for example, would make basic coverage available to tens of millions who now have none. It would curb the practice of denying insurance to persons with “preĆ«xisting conditions.” (We’re all born with a preĆ«xisting condition: mortality.) It would make insurance coverage portable, which would be a boon for both individual careers and the wider economy. Even one of these things would be a colossal improvement on the status quo.

But the Blue Dogs are playing a dangerous game of chicken. Even if they’re right that reform would do too little about costs, the alternative—which, as the President has repeatedly pointed out, is the status quo—would do nothing. Ultimately, real cost control will require a strong push away from fee-for-service medicine. In Massachusetts, which three years ago enacted its own version of near-universal health insurance, the cost of expanded coverage has created pressure for just such a push. That state’s experience suggests that the cost problem, too, will be easier to solve under a reformed system, with all its other benefits, than under the one we have now

Read it all at The New Yorker

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