Health Care

http://www.npr.org/templates/story/story.php?storyId=112687935

I'm overseas and missed Obama's speech, but I was surprised to see the "You lie!" outburst on CNN this morning. The look on Pelosi's face was priceless - she would make a good boarding school headmistress if she ever tires of being 3rd in line to the presidency. Do you think much of America watched the speech and could be swayed, or are their minds mostly made up? Well, maybe it was mostly meant as a jolt for Congress and rebutting right-wing media's attacks.

Plus that Rep. got worked up over something so ridiculous. Although it would be humane to give some medical assistance to illegals, even if they don't want to, the costs of minimally covering that population are miniscule in the grand scale of the reform plan ($880B over 10 years at least).

I wish Obama would just come out and say, "Why are you imagining all these evil motives for our health reform? Do you think I ran for president so I could institute death panels and put insurance companies out of business? Believe it or not, we actually want to make your lives better and our country stronger, and health reform is an integral part of that. I understand that people can be distrustful of expanding government and new regulations, but at least be equally skeptical to my opponents like right-wing media and the insurance and medical lobbies. What about their ulterior motives and conspiracy theories? Maybe then you'll see I'm not so bad."

But again, Obama seems to be light on details in his big speeches. He spent a lot of time reassuring America about the things his health plan won't do. I know the bill is enormous and many details have yet to be ironed out, but at least give us a 30-second overview of how the plan will make us better. The Dems say 80% of the legislation is worked out; ok so tell us then. Unfortunately I think a lot of America still doesn't understand what he is trying to do (most Americans don't even understand what health coverage they have, nor how the industry works at present), so of course the fear-mongers fill that vacuum with a lot of rubbish.

And unfortunately I think Obama still wants to hide some of the costs of his plan from us, so as to avoid more lost support. But sooner or later he has to level with us that any meaningful health reform will cost something. We won't get by just by trimming waste and taxing the rich more. To cover more people, we will have to spend more, and to reduce per-capita costs, then we'll have to reduce some services. The CBO concluded that Obama's numbers are wishful thinking, and a zero-debt health reform is either impossible or insignificant. But those sacrifices could reap huge rewards, since so much social and economic productivity is lost due to complications from uninsured sick people and unequal employer-based insurance. Plus we could theoretically recoup some funds by capping malpractice settlements which would lower premiums (not so popular with the Dems) and taxing health-poor products, such as fatty junk foods and alcohol, to promote healthier living as we've already done for cigarettes (wishful thinking though).

I don't think it's realistic for Americans to expect that their health coverage (or any service in fact) to be immune to change with the times. Maybe some of us have "great coverage" now or in the past, but in the future we won't, or we'll have to pay ridiculous sums for it. The nature of group coverage and health policy is communal, so unless we're super-rich, we can't hope to remain on our individual islands, detached from the less fortunate among us, enjoying access to all the best treatments. Maybe our taxes will have to go up slightly, and maybe Medicare benefits will decrease a bit. Call it "socialist" and "rationing" if you want, but what do you think your HMO is doing to you now? The healthy pay for the sick. Try getting an MRI for a bruised knee, or an exotic, expensive drug when generic alternatives are available, and see how accommodating they are. And they have the luxury of denying service to cost-negative individuals, which Medicare of course can't do. Obama wants to cover the uninsured and hold insurers/medical providers accountable to provide more bang for the buck. How can that be bad for America? The Dems have to do a better job clarifying the issue. Of couse if Obama's plan calls for too many sacrifices in order to cover the uninsured, then it doesn't make sense (except morally). If that price is too high to pay, then we can stick with the feudal health care system we currently have.