Fasten Your Seatbelts: Bumpy Ride Ahead

By Paul Greenberg (Archive) · Wednesday, January 6, 2010

Winston Churchill was talking about Russia when he spoke of "a riddle, wrapped in a mystery, inside an enigma," but he could have been describing the 2,000-page heath-care bill now past the U.S. Senate and into law -- after it's been melded with one just as big and indecipherable out of the House. Then the two mysteries will be twice as tricky.

The country won't find out about all the special clauses, side agreements, sweet deals and arcane exemptions tucked away in the final version of the bill till it's the law of the land. If then. But if a dazed observer of this semi-secret process had to sum up what has happened, this would be my best guess/stab in the dark:

The country's broken system of health care won't be fixed, but it'll be broken on a much bigger and more confusing scale. Which figures. After all, this unsystematic system has been patched together willy-nilly over the past half-century, one addition and expansion piled atop another without any clear, comprehensive, unifying plan. It's not unlike making a coat out of patches.

Yes, more people will have insurance one way or another, which is a good thing. They'll have to have it. It'll be the law. Even those who don't want it, or will be hard-pressed to afford it, will be required to buy it. Which may be one of the few realistic aspects of the administration's approach, much as Barack Obama opposed it back in last year's presidential primaries. There's no other way to have the young and healthy pay the premiums that will cover the medical costs of the old and ailing. That's the only way a universal system of health insurance can work.

But after that bow to reality, the view grows dim, and dizzying:

While the new, expanded system will cover some 30 million more Americans, the new bureaucracies, higher taxes and crushing deficits required to run it will go on approximately forever. The administration says it's going to save money by spending more. That approach has been tried before with a signal lack of success. See the massive deficits that Medicare and Medicaid are piling up even now.

As the years go by, it will become harder and harder for patients who are dependent on those programs to find doctors and hospitals financially able to accept them. Especially as hundreds of billions are cut from Medicare to finance this latest expansion -- without a concomitant expansion of the number of physicians, nurses and hospitals in the country.

Health insurance is going to be more available, all right, but not health care. On the contrary, it could grow scarcer as more and more dollars chase fewer and fewer medical services -- the very definition of inflation. Never mind. We're supposed to believe this administration has repealed common sense. Congress will just cut benefits in the future to make up the deficits. And the sun will start rising in the west.

Some of us would have preferred a reform that gives patients more choices and more responsibilities. Instead, this approach will expand government's role in almost everything to do with health care, from financing it to regulating it to running ever larger deficits to finance it.

Some of us would have liked to see the government require insurance companies to offer lower rates to people with healthier habits, like non-smokers. But the administration's proposals have little to do with improving the health of the American people; they focus on insuring the sick, not creating incentives for Americans to stay healthy.

Real reform would have allowed consumers to buy insurance across state lines and let Americans reap the considerable benefits of wider competition, but not this "reform."

Real reform would have done something to control the costs of lawyering that physicians now have to work into their fee schedules. It's called practicing "defensive medicine" -- not in order to serve the patient but to guard against frivolous lawsuits. This not so little problem goes unaddressed, too. Democrats collect too much in campaign donations from plaintiff's lawyers to tackle it.

Final result: The country will wind up with another sprawling layer of health-care legislation added to all the others that have been enacted over the years without any real vision or comprehensive change. Ring out the old; ring in a lot more of the same.

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