Monday, March 30, 2009

The Reluctant Optimist

I’m fascinated by the delicate “plate spinning” the Administration is using to avoid a calamitous crash. It feels like they keep adding another plate (a very pretty, shiny, distracting one) to keep us from noticing the three on the other end that are woefully close to coming down. I hear folks talking about the shift in focus from the economy to energy, or health care, or the tax code, or the new herb garden on the White House grounds. But the health care piece, especially, feels like an unnecessary distraction.

I just don’t see a scenario where meaningful health reform happens. Chairman Baucus balked at paying for it out of the deductions of high earners. Many more oppose taxing employer-offered benefits. Even if they could agree on what to do, no one seems to know how to pay for it. I keep hearing individual members of Congress talking about working on “the 80 percent where we agree,” but 80 percent seems like an awfully high bar for agreement. If they truly agreed on 80 percent, wouldn’t they have already done a portion of it?

I’ve always thought the problem was this: we want health care to be both a business, with competition and yes, profit, and we want it to be a state-given right for all citizens. We can’t figure out how to have both. The private sector could introduce all sorts of efficiencies and common-sense to the system, but we can’t get out of our own way as a country to let it happen. We have to stop talking about the system we’d create now, if we were starting from zero. That ship has sailed. Too many stakeholders are too married to some portion of the haphazard system we’ve created to let it be dismantled. Like it or not, this hodge-podge, quasi-entitlement, public/private mess is our system. It’s imperfect, it’s bureaucratic, it’s inefficient, it’s outrageously expensive. But until Washington is willing to allow the sacrifices that would have to be made to undo what we’ve got, I think the best we’ll get is an expensive distraction.

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