President Obama is meeting stiff resistance from even his own party -- and from the American people. This is evidenced by the President's willingness to retreat on the government run option, begging the question, what else is wrong with the Administration's proposal?
In the formulation of national health care policy, time is both a constraint and a resource. Time is a constraint for a President who knows that his popularity is likely highest in the first three to six months of his Administration. It is a constraint for a President who wishes to strike while his iron is hot, and to follow the advice of his chief of staff, Rahm Emanuel: "Never let a serious crisis go to waste."
The health care industry, unlike financial services, has not imperiled the global financial system, necessitating rapid emergency regulatory intervention to prevent catastrophe. Few will deny that the cost of health care and its accessibility should be part of a national debate -- but the President is trying in just a few months to railroad a solution, lest his ratings continue to decline.
Time, however, is a resource for those who must perform extensive due diligence on health care, which represents a monumental 17% of U.S. GDP. This economic activity is equivalent to $2.4 trillion, which is slightly more than the entire GDP of Great Britain, the 7th largest economy in the world (purchasing power parity 2008 estimate). Why the White House wanted decisions of colossal importance to be made by the end of August would seem a decent question, especially when they address economic, medical and ethical issues that have been decades in the making.
The value of an extensive national debate is to inform the public about a complex subject that affects us all. It permits focus on issues on which the Administration has been largely silent. First, capping malpractice liability, also known as tort reform, is not addressed. While malpractice insurance raises the cost of health care to the patient, a knock-on effect is the overprescribing of some tests and procedures, due to an abundance of caution in a litigious culture. The Economist refers to evidence that Americans could reduce between 10% and 30% of health costs by eliminating unnecessary medical procedures and prescriptions.
Second, the sponsors of the bills do not address incentives for adopting good life style choices and a national education program to support this. If we are to radically overhaul health care, shouldn't there be incentives for making positive decisions about personal behavior, and as some must be asking, in order to improve outcomes, shouldn't there be higher premiums for behavior that is reckless or unwise?
Third, and as reported in the Wall Street Journal, the Pew Hispanic Center reports that about 50% of the 12 million illegal aliens in the U.S. do not have health insurance, and they are lawfully entitled to free emergency treatment which cannot be denied. In view of the cited McKinsey & Co. estimate that the same care at a primary facility would be 10% to 15% of the cost of delivery in an emergency room, the effects of illegal immigration on the national health care debate must be brought to light based on present and future demographics.
Finally, the debate should take time to include discussion of other national role models and what their effectiveness is. Level of co-payment, rationing and waiting lists, restriction of physicians, technology, and consistency of quality must be taken into account with any so-called universal coverage program -- along with the level of deficit required to sustain it. To achieve a collective understanding beyond sound bites about countries such as France or Canada requires analysis, thought, and dialogue on the airwaves and in print.
For a White House that prides itself in text messaging and Tweeting, it could be more adroit at communicating its message succinctly. The ridiculous image of "death panels" for seniors put forth by Sarah Palin, while a grotesque misrepresentation of the Administration's approach, has been a more effective, albeit negative, brand moniker than all the President's mellifluous and numerous words. Through ineffective communication, the President has allowed his political adversaries to define him.
Until we know at the individual level what health care reform will cost and what the benefit will be, we will not have a well-informed electorate, and there will be vulnerability to fear-mongering and misunderstandings.
In view of the complexity of the issue, the economic scale, and the amount of misinformation in the mainstream, the country needs a scarce resource in order to evaluate and assimilate: Time.
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