Broader Health Care Comes First, The Pain Later

The health care bill passed by the House last night takes America's well being over an important hurdle by making health insurance available to 30 million people. It's not a landmark that revolutionizes anything -- there are 20 million people still "naked" -- and it's going to be very expensive. This legislation patches some of the holes in our existing heath care, it creates many new ones. But we've moved in the right direction, and in spite of the political pollution and dissembling on both the left and right, I admire the public servants that stuck with it.

Our health care system is an aspect of our society that we should be proud of, but how many of us are? The U.S. turns out much of the innovation in pharmaceuticals and testing and techniques, yet we spend far more than our developed nation counterparts with inferior results (unless you're a senior executive of a health insurance company).

I guess the problem starts with the nature of our system. After WWII, the government imposed limits on wage increases in order to control inflation, and employers were allowed to provide health insurance to their workers as a sort of back-door raise. (I learned this in an article in The New Yorker last year, but you can't click to it without a subscription.)

Much of the system is indirect, so there's been no one keeping an eye on the ball of costs. State insurance departments oversee the rate increases, and employers shrugged off the expense for a long time until the middle 1980s, when rather than fight rate increases to reform the existing fee-for-service system, businesses bought in to the dopey HMO arrangements no one has ever been happy with.

The pain? So far, several new taxes have been announced to pay for the incremental costs: taxes on investment income for people earning over $250,000, and higher Medicare withholding as well. The states are going to have to fund greater Medicare costs too -- on teevee this morning I heard $200 million a year for Ohio, and a multi-year figure of billions for Texas, and the respective governments don't know how they're going to pay for it.

There are positive aspects -- people won't be shut out because they're sick. And even if it costs a lot, which it will, a healthier population will be more productive and creative.

Thanks to the Democrats for fighting this good fight, but don't stop with this bill. Personally I would be satisfied with a high-quality single-payer program (yeah, socialism, I know). But that's not likely, so now we need to move to greater competition among insurance companies, lower-cost drugs, and more incentives to take up medicine as a profession.

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