There’s a lot of sturm and drang, and understandably so, about the details of the various health care bills that are circulating in Washington. Trying to keep up with the minutiae will literally make your head hurt. So maybe we should come at it from another angle. Instead of focusing on details, let’s focus on the problems the various bills are intended to solve.
The reason health-care reform is so difficult is that it presents three mutually re-enforcing problems. First, we want to expand health care to as many people as possible. Second, we want it to be very high-quality care: we want unfettered and immediate access to the best doctors, drugs, diagnostics, and procedures. Third, we want someone other than ourselves to pay for it: very few of us are willing, much less able, to pay out of pocket for the high-quality care we want.
Hence the dilemma. It’s relatively easy to come up with a system that addresses any two of these three problems. But it’s virtually impossible to design one that adequately addresses all three. For instance, you could design a system that gives you immediate access to high-quality care and covers everybody. Let’s call this Option A. Option A already exists, in point of fact: anyone with the means to do so can go see a doctor and pay out of pocket. But since few can, the “expansion” is for naught.
Alternatively, we could fix the expansion and affordability problems by rationing care. We would only be able to consume a certain amount of health care, after which point we would either not be able to obtain extra care or we would have to pay out of pocket. Let’s call this Option B. The problem is that Option B, by rationing, sacrifices “immediate access to high-quality care.”
Finally, we could expand coverage to (nearly) everybody, and make sure the coverage is high-quality. Let’s call this Option C. The issue then becomes, who pays for it, since by definition most of the newly insured cannot?
If we understand these problems, then we’re better able to discuss the various proposals. But candor requires that we first acknowledge that we cannot have it all. There is no magic bullet that would solve all three problems identified above. No, the best we can hope for is two out of three.
Put another way, the Obama Administration can only hope to pass the “least worst” alternative. We can toss out Option A: it doesn’t expand coverage. We can also toss out Option B: other industrialized countries may be comfortable with rationing (can we come up with a less pejorative term?), but the United States certainly is not..
The $64,000 question is, then, who pays for it and how?
This issue – who pays, and at what cost? – is really the nub of the debate between public option adherents and others.
I’ll discuss the much-maligned Baucus Plan in the next installment, and the Public Option in the third.
related story: Health Bill Survives Attacks — vote by week’s end?
**Alert** Franken offers health insurance bill
WASHINGTON, D.C. — Sen. Al Franken, D-Minn., who took office this summer, has introduced his third piece of legislation, titled the Fairness in Health Insurance Act of 2009.
The legislation would require that 90 percent of every premium dollar spent on health insurance go to actual health services. The remaining 10 percent could be used on administrative costs, advertising and profits.