The health-care debate must get down to specifics

The health-care debate must get down to specifics

There is more to health-care reform than talking about the uninsured. Of course that’s an issue, because the cost of treating the uninsured is eventually carried by everyone else, one way or another.

But it’s not just about whether 47 million people don’t have insurance, or about how many of those millions are uninsured by choice or temporarily or are illegal aliens (who some suggest should be greeted at the hospital door by an immigration officer and shipped back from whence they came).

Health-care reform must focus on a complex combination of factors that have made health care in the United States the most expensive in the world, but health outcomes for Americans-at-large near the bottom of industrialized nations.

It cannot be ignored that Americans will spend about $2.5 trillion on health care in 2009, which is 17.5 percent of the gross domestic product. That means that of every $6 in the American pocket, $1 is being spent on health care. And costs have been rising at a rate much faster than the GDP. They have been doubling every eight to 10 years, and will continue to double at that rate without some kind of intervention.

Even if Congress acts in 2009, the U.S. health-care system has evolved over nearly a century to what we have today. It is not going to be changed overnight, any more than a battleship can be turned on a dime. But steps have to be taken to rein in costs, provide portability of coverage and ensure the coverage of pre-existing conditions.

Now it gets complicated

That’s a simple overview, and, as newspaperman and social critic H.L. Mencken wrote, “For every complex problem there is a solution that is clear, simple and wrong.”

When Mencken died in 1956, the nation was in transition from a simple doctor-patient relationship to a relationship in which health insurance companies, employers and government now come between the doctor and patient in varying degrees and to various effects. If ever there was a simple answer to what ails us, it’s been gone almost as long as Mencken has.

And so it shouldn’t come as a surprise that just one of the four health-care reform proposals working its way through Congress is 1,026 pages long and tedious beyond description. If it were readable and concise it would, following Mencken’s logic, be wrong.

Which is not to say H.R. 3200, America’s Affordable Health Choices Act of 2009, is right just because it is long.

What must be said is this: It is time for President Barack Obama to tell the American people exactly what he believes is needed to achieve his goals for health-care or health-insurance reform. And it is time for him to work with Congress to achieve a legislative response to health-care problems before they evolve into a crisis that not only cripples the health-care system, but that threatens the nation’s economy.

Companies are now paying an average of $13,000 for family health coverage for each employee; not many can afford to see that number grow to $25,000 in eight or 10 years, as the Congressional Budget Office has predicted. Increasing copayments being required of employees are cutting into family budgets and diverting spending from luxuries first, then from other family necessities. That eventually retards economic growth in every area of the economy except health care.

Obama must stop waffling — in recent days the administration has sent mixed messages on something as basic as whether the president believes that a public option is vital to the health-care reform he envisions. By the time Congress returns to Washington, there should be few questions about what’s negotiable and what isn’t. That’s the only way Congress can seriously debate one of the most important issues facing the nation, an issue that until now has largely been defined by generalizations, slogans and, far too often, fear-mongering.