View From Down Under

There is no doubt the US health care system needs reform.  Costs are high relative to outcomes, outcomes are very unevenly distributed, the cost of health insurance is greater than the average mortgage.  Perverse incentives create perverse results.

But the US political system appears to have lost all capacity for meaningful reform.  The bills currently being debated are not much reform at all, and look likely to add to the overall cost and inefficiency of the system.

Part of Barack Obama’s campaign platform was comprehensive health care reform.  So after his inauguration and passing the economic stimulus package, the President called on Congress to develop a health care reform proposal to make coverage affordable to all Americans.  It seems odd that the President would not propose his own plan (like the one he campaigned on), instead of delegating that to Congress.  However, the last time a President proposed a health care reform plan (Bill & Hillary Clinton), the process was handled so poorly and the results so roundly criticized it kept health care off the legislative agenda for nearly 20 years.  Obama wants a bill passed, and the only way to do that in the current political environment is to let Congress figure out what it can pass, and sign it.

Congress responded with some grand rhetoric and then slipped back into their normal, self serving process of getting themselves re-elected.

The result will be a bill that adds more bureaucracy to the process, and does not address many of the important problems.  The current bills do nothing to control costs or improve quality.  There is plenty of data available to suggest that major reforms can improve both cost and quality.  For example, the evidence is fairly clear that a tax funded system is less expensive and with better health outcomes than an insurance funded system.  But of course that is “socialism”, despite the fact that it works well in almost every capitalist country in the world.

The only thing worse than passing this legislation is not passing it.  Reducing the number of uninsured is an important and worthwhile change, with positive flow on effects for all Americans.  If the final bill does not pass both houses of Congress, not only will millions of American continue to lack affordable medical care, but it will likely have the disastrous effect of once again pushing any health care reform out another 20 years.

The view from down under is that meaningful health care reform in the US will require one of two things to happen first: either the US political process is itself reformed; or the health care system reaches an unbearable crisis point.

The saddest thing is the amount of unnecessary human suffering that will occur before that happens.