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Sunday, Jul. 05, 2009

Will America find resolve to reform health care?

Americans are having a tough time finding common ground on health care reform.

Sure, most everyone agrees that changes are needed, but that's turning out to be an awfully narrow patch on which to build a bipartisan coalition.

We can't even agree on the size of the problem.

Most of the media and politicians cite the Census Bureau's estimate, which shows 47 million Americans are uninsured.

But some conservatives question the wisdom of using that figure for formulating health care policy, since it includes some large groups that aren't really targets for reform.

Illegal aliens, Americans who could get insurance but opt out and people who qualify for existing government programs but haven't signed up are all lumped into the Census Bureau estimate.

Of course, no one is completely without access to health care in the U.S., since hospital emergency rooms are required to treat anyone who shows up.

However, it's hard to imagine a more inefficient system for providing services to folks without insurance.

Figuring out a way to cover the uninsured isn't the only challenge for health care reform.

For almost all of us, the combination of a job loss and a serious illness would mean financial ruin.

A new study in the August issue of the American Journal of Medicine concludes that medical problems contributed to more than 60 percent of all bankruptcies in 2007.

These days, it's likely that bad mortgages and credit card debt account for a far greater portion of bankruptcies than they did two years ago.

But it's interesting to note the study found that nearly 80 percent of Americans bankrupted by medical problems had health insurance when they first got sick.

Even if we manage to avoid catastrophe, reining in runaway costs is still crucial to our financial health.

In 2007, Americans spent $2.2 trillion on health care, according to the White House Council of Economic Advisers. That comes to $7,421 per person, or 16 percent of gross domestic product.

Without major reform, health care's share of GDP is projected to rise to 28 percent in 2030 and to 34 percent in 2040, the council concluded.

Is the White House exaggerating the extent of the problem to push through policy changes? It's possible, but most Americans don't need hard data to know that the health care system is in trouble.

Our pay stubs confirm that health insurance premiums are a growing burden on average Americans. Each year, we pay more and get less.

It's a trend that's impossible to sustain, and still we're at loggerheads.

We can't agree whether a single-payer option would complete America's shift toward socialism or merely bring some much-needed order to a system that's clearly out of control.

We can't agree on whether state governments or a federal bureaucracy ought to be in charge if we create a new public insurance program.

And while polls show that most Americans want health care reform to include a public insurance option, the American Medical Association, private insurers and the pharmaceutical industry are all opposed to the idea.

Free-market champions on both sides of the aisle may join forces to kill any bill before Congress that includes an optional government health plan.

But if market forces alone could fix America's health care system, they would have by now. Clearly, some other pressure is needed, and a public insurance option seems about the only viable idea for applying it.

Unlike most criticism of government programs, the fear isn't that a public option would be inefficient, but that it would be so good private providers couldn't compete.

But how else to force change? A public option that's inferior to what's already available wouldn't be much of a catalyst.

It's uncertain whether opponents of the proposal have anything to fear. At this point, there's a real danger health care reform will collapse under the weight of a polarized nation.

If you need a model of how intransigent views can stall progress on a pressing national issue, just take a look at the immigration debate.

The inability to find some middle ground hasn't only halted sweeping changes, but it has also stalled virtually any progress. We're left mired in an intolerable situation, sinking deeper into a pool of "nonstarters" and "deal killers."

If we can't find a new vocabulary for framing political debate, health care reform is headed down the same path.

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