Our illusions about health care

This commentary also appeared in the Chicago Tribune

Sen. Edward Kennedy's 651-page bill reconstructing America's
health-care system is any indication, the next few weeks will be
confusing and exasperating.

Immodestly speaking, the
Massachusetts Democrat thinks the government can bestow on Americans
long-term care insurance for a far-fetched $65 a month. Right there is
a great example of what the approaching weeks will be like as Congress
opens debate on every utopian and fly-by-night idea for creating a
perfectly healthy society, for a lot less than we're paying now. If
there's ever a time for Americans to be skeptical, it's now, because
the stakes may never be this high again.

What some are proposing
to do with health care is akin to trying to take apart a wheezing old
diesel engine and then, by adding a few new parts and a lot of
stargazing, turn it into a jet aircraft engine. It has all the earmarks
of President Barack Obama's fantasy that everything can be upgraded to
excellent, if not perfect, condition in a few weeks by blindly blowing
hundreds of billions of dollars out the door.

As a wise
professor of mine once said, when you want to create or change public
policy, what exactly are you trying to do? You've got to bore through
the rhetoric, dogma and politics to find the heart of it. Do you, for
example, want to insure every American for the sake of insuring every
American, or is the goal to improve every American's health?

keep hearing that we must provide medical coverage for what the Bureau
of the Census says are approximately 47 million uninsured Americans,
but there's no discussion of whether that's the goal itself, or a means
to the goal.

It's made more difficult because the Census
Bureau's survey doesn't delve deeply into why 47 million are uninsured:
Because they're young and healthy and don't want to be covered? Because
they can't afford it? Because of a disqualifying prior medical
condition? No doubt, for all those reasons, but in what proportions?
Also ignored is what proportion of the uninsured is nonetheless
receiving health care through Medicaid or the State Children's Health
Insurance Program. (By the way, the same annual survey shows that the
number and percentage of uninsured children continues to decline.)

you can't answer those questions with precision, you can't design a
program that will do what the ultimate goal is -- better health care
for all Americans, regardless of whether it is through an insurance
program or some other way. For example, if 10 percent of the 47 million
are young and healthy and don't want to be insured, forcing them all to
buy a policy isn't going to do much to finance the new system. If 10
percent of the 47 million are involuntarily uninsured, then the problem
isn't as bad as it is described, so we can ask: Why are we rebuilding
the whole system?

Gets complicated doesn't it? Perhaps such
questions will soon be answered with clarity. But my hopes aren't high
because these kinds of questions have been persistently ignored in the
health-care debate.

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