Originally published on November 27, 2009
Charles Krauthammer’s appeal today for three simple fixes to our current health care problems seems perfectly sensible, reasonable and low in risk. Although these fixes (malpractice reform, interstate competition and deductability reform) even if well designed and fully implemented may not solve all of the problems with the health care/health insurance system, they are likely to step the system in a favorable direction. Most importantly though, they are changes that are low in risk because they do not involve a complete revamping of the entire system and more importantly, if they didn’t work they would be more easily reversible.
The problem is that simple fixes such as these are politically impossible to implement. As he highlights, powerful special interests have prevented any of these ideas from rising to the top. This is a standard story in Washington. Although the motivation for reform is to help the “consumer” of health care, the way in which reform is implemented is to protect, or advance, the interests of particular special interests like the trial lawyers group, or the union workers, or the health insurance industry. Each of these groups represent a small share of the US economy and still they command a disproportionate effect over the policy choices considered by the government.
I’ll admit that I don’t know many of the details of the current bill, but I am confident that for each set of passages in the 2000+ page bill there is a small group of individuals who recognize that the rules described in that passage will open up an opportunity for them: e.g. Group X sees benefits on pages 355, Group Y sees benefits on page 1567, etc. For the general consumer though, no one can point to a particular passage … instead consumers are expected to have faith that somehow this complicated new system will work to their benefit.
The political process that generates these kinds of outcomes is what needs fixing. Unfortunately, I haven’t heard many good ideas about how to do that. Mostly politicians say we need more “resolve.” Fred Barnes writes about this problem in today’s WSJ. He highlights how little President Obama has been able to accomplish regarding his campaign promises to change the lobbying culture in Washington. Indeed the problem has probably gotten worse. The reason is simple .. put more money on the table and more people show up to try to secure a share of it. The reverse is surely true too … put less money on the table (i.e., reduce the size of the government) and fewer people will show up. Of course, how to do that seems to be even more impossible in today’s economic climate.
