Photo above: The Hertford Bridge in Oxford, England. Used by Permission. © Tom Ley 01302 782837

Monday, November 23, 2009

Congress and the Haste for Health Care Reform by Douglas O. Walker

The Reid health care bill has now passed the Senate and proceeds to a formal debate on the Senate floor. It brings to mind not only the importance of this health care legislation in how it will affect all Americans but the importance in the way it is being enacted.

Needless to say, many controversies surround the question of health care and the vote to proceed merely sets the stage for an epic battle between those that regard the bill as essential to improving access to health care by many millions of uninsured Americans and those that regard the bill as not only an objectionable takeover by the government of the nation's health care sector but an unacceptable intrusion into their personal life and health care decisions.

Beyond this great debate is the very manner by which legislation of this importance and sweeping ramifications has been put together and foisted upon the American people. In a matter of a few months a few dozen people in Congress meeting in secret with representatives of a few special interests cobbled together several bills to restructure one-sixth of the U.S. economy. During these discussions, the details of the bills under discussion, to the degree they were known, changed from day to day as special interests had their influence on the evolving text and the compromises necessary to induce key legislators to support a bill were introduced. It is generally agreed that both the House and Senate bills are almost incomprehensible and many of their details, most notably key elements of their financing, remain to be defined by later legislation.

The very manner by which these bills were put together precluded any substantive discussion by the House and the Senate (not to mention the country at large) of the important questions entailed in such a major change in public policy and how it might impact the country. Here are some of the questions that should have had a through airing by the Congress and public before this legislation is approved:

• Does improving access and the delivery of health care require a big, new government-dominated system or can the existing set of more informal arrangements be improved to deal with problems all agree need to be addressed?

• Is it financially and technically possible to cover all those not now covered by some form of health care insurance? Should non-Americans such as legal and illegal residents be included in any program to widen access to health care? Does the government have the Constitutional power to mandate its citizens to purchases health insurance?

• Exactly what should be covered in any government-supported health care program? Will it cover preventive care, mental health, abortion, chiropractors, elective services such as plastic surgery, and a host of other kinds of non-essential health care needs?

• Can a nation already deeply in debt and facing the prospect of huge increases in existing entitlement expenditures afford an expansion of expensive government-supported health care services? How, exactly, will any needed revenues be obtained? Who, exactly, will be the source of these revenues? What, honestly and with credibility, will be the costs of this legislation and its impact on the deficit? Given the huge deficits involved, Why should future generations pay for the health care of this generation?

• Given the large increase in taxes now being discussed, Why, as a matter of political responsibility, should the people to be taxed be forced to pay for the health care of people they do not know and have not way of comparing the needs of these people against the needs of their own families? Why will they be placed in criminal jeopardy if they fail to meet the demands being imposed upon them?

• How can the rapid rise in health care costs be restrained in a way that does not destroy the incentives of the health care industry in general and providers in particular to deliver quality health care services? How can we expand our existing health care capacity to meet the nation's growing demand for health care at least cost?

Proponents of the legislation now before the Congress claim these questions have been answered. But of course they have not and could not have been adequately answered in the short time Congress has been discussing health care reform.

In its haste, Congress is on its way to introducing an expensive disaster that will set this country back decades in the quality and availability of the health care now enjoyed by most Americans. Restructuring a large part of any economy, after all, is a process that should be undertaken in small steps over many years as it involves great complexities and hidden interrelationships that no one understands.

I for one am amazed that Congress does not see that even the most committed central planners of the old Soviet Union would not try and restructure their economy in this irresponsible way.

No comments:

Post a Comment