Health reform: Beyond the numbers

The Atlantic‘s Derek Thompson put it beautifully (via Jon Cohn):

One side doesn’t want to spend more money to insure more Americans, and the other side wants to pay for their insurance with tax increases and spending cuts. The numbers are beside the point now. This isn’t a math problem, and it’s not even really a debate anymore, it’s a calcified difference of ideology.

I want to be very clear about this: in principle, there is nothing wrong with either side’s position. I share the priorities of one side and not the other, but that doesn’t mean I’m correct and others are incorrect.

Ultimately, I suspect nearly every American would want everyone to have access to affordable coverage without bankrupting the country. If that were all we had to agree on, we’d be done. Unfortunately, the means to that end matter.

We’ve spent over a century trying and failing to reform our health system. The signature of that failure is written in the confusing, dysfunctional patchwork that has evolved. With each successive law and innovation, the system changed, sometimes for the better, but not always in a broadly bipartisan fashion. In 2003, Republicans had the majority and will to reform Medicare. It was their watch and it was their law. Consequently, the Medicare prescription drug benefit is their legacy, as are its costs.

Almost a year ago we took a major step, though only the first step, at more comprehensive health system reform. The chosen course more closely resembles the preferences of today’s Democrats (though yesteryear’s Republicans). Whether through good fortune or skill, Democrats amassed the will and means to push something through. The window of time was brief and the range of the politically possible narrow, but something passed. It was their watch and it is their law, their legacy, benefits, costs, and all.

In principle we could  and go the other way, repeal the Affordable Care Act. It won’t happen soon. It likely won’t happen ever. But the law will be amended, as it should be. We’re not done with health reform. I hope we can compromise on enough elements of future enhancements to health reform so that everyone feels invested, everyone feels part of the solution. I don’t know if that is possible.

One thing is certain, we can’t have it both ways. Coverage expansion and minimizing costs can’t both be top priorities. One comes first. Now that we know which one, let’s start to work on the next priority. Political leaders of both parties have expressed concerns about health care costs. Are they concerned enough to put old arguments to rest and get to work on doing something? I’m not naive. I know it’s not likely, not soon anyway.

Paradoxically, I also know that it’s inevitable. Health care costs can keep gobbling a larger share of the economy for many years, but not forever. Some Congress will do something about it, though perhaps not in our time. The health reform debate may have gone way beyond the numbers today, but at its heart there is still a math problem we don’t know how to solve.

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