Obama tries to reform medical care

President Obama isn't getting the health care deal he had wanted before Congress leaves town for the August recess, but health care reform could still happen this year. Just what form it might take remains unclear. Count me as cautiously supportive, sort of. I don't buy the notion that health care is a "right"; it's mentioned nowhere in the Constitution or Declaration of Independence. However, I do think a compassionate society should not allow treatable illnesses and injuries to go untreated simply because of economic circumstances.

Although I am congenitally skeptical of any new government program, I grew more sympathetic toward changes in government-backed medical care throughout the 1980s and early 1990s, when the health insurance premiums I paid grew and grew while my out-of-pocket expenses for co-pays and deductibles also grew. When I took a new job in 1980, I was disappointed to learn that my new employer would not pay for my family health insurance coverage, as my former one did. The family premium at that time was $58 and change. Family coverage at the same company, but with more out-of-pocket expenses, is now around $600, I think. When my children, who are now paying for health insurance for their own children, were comparing costs last weekend, they considered a $600 monthly premium something to be envied.

America's health care system is overlapping, bureaucratic, top-heavy, insensitive and far more costly than other industrialized nations, and it's been like this for years. It looked like President Clinton would be able to push through health insurance changes in his first term, but Clinton blew his opportunity by assigning his wife to lead a secretive commission that created a gargantuan, bureaucratic system, which Clinton then presented to Congress as a fait accompli. No changes allowed! The proposal collapsed and died after attacks from left and right and from deep suspicions about the secretive, no-changes, no-debate nature of the proposal.

Obama has not accomplished what he set out to do, but his legislative strategy has greater chance of success. Obama wants a health care reform plan, and he's allowing Congress to work out the details. What will emerge will not satisfy those who want a single-payer plan that would strip away all of the insurance company profits and second-guessing, nor will it satisfy those who, out of fear of governmental inefficiency and meddling, think the current system is just fine.

Some key inequities in the current system need to be resolved. Because of the huge cost of extended care and chronic diseases, Americans are just one serious illness away from bankruptcy. People who have good health insurance coverage through their employers are afraid to change jobs and lose their coverage. Layoffs mean not just loss of income but also loss of health care benefits (COBRA helps, but it's prohibitively expensive for many people). Insurance companies can refuse to cover "pre-existing conditions" and scour health records for any disqualifying evidence. (My daughter is having to prove she never had cancer because an infertility drug she had taken three years ago can also be prescribed for cancer patients.)

Statistics I've seen recently put the cost of health care at around $7,500 per person. Economies of scale, if nothing else, should reduce that amount, and other reforms should reduce costs further. Cutting these costs will benefit the economy by improving America's competitiveness against other nations' workers, who have universal health coverage. Getting the uninsured into coverage will reduce the un-reimbursed expenses and write-offs of hospitals around the country.

There are good reasons to hope that health care reform will pass. There is even greater reason to hope that Congress will do this work wisely, without increasing the national debt and without negating the many positive aspects of health care coverage — innovations, research and technology, for example.