By now, almost all the arguments—pro, con, and equivocal—regarding health policy overhaul in name, if not in substance, have been recycled and nearly exhausted. And the relentlessly winding procession toward a near-term political disaster for many Democratic officeholders and a potentially longer-term policy disaster for most Americans will roll on, beyond a tedious House-Senate conference in the new year. Any foreseeable final product promises to make complaints about our current healthcare pale by comparison—we’ll see higher taxes, budget deficits, regulatory burdens, disruptions of current insurance coverage, and political hijacking of personal medical decisions.
However, as one listened to Democratic Senate leaders alternately wax and drone on in this weekend’s late-night floor debate, their four most dominant themes stood out. First, private insurers are villains to be demonized (or “Don’t hate us as much as you despise them!”). Second, after many decades in the political desert, the end of a long, multigenerational crusade to establish the guarantee of healthcare insurance as a fundamental right is in sight. Third, just look and marvel at what we politicians are “giving” you (just don’t ask who actually pays for this holiday fruitcake and whether you come out ahead). Fourth, this is just the beginning of healthcare politics 24/7/365 to perfect the imperfectable. Rather than reform a handful of fundamentally flawed incentives in health policy and empower individuals to make better choices, both the Senate and House bills fall back on the fatal conceit that a few hundred designated chosen experts can overcome the ingrained preferences, instincts, and self-interests of more than 300 million Americans.
The Republican resistance to this great leap backward has been spirited and surprisingly persistent. However, it relied predominantly on an avalanche of disturbing numerical criticisms (costs more, less filling; with more losers than winners) and spotlights on unseemly deals, delays, and detours. Republicans mostly rode the wave of mounting negative opinion about the apparent contradiction of “health reform.” With a few exceptions, they failed to present effectively an alternative vision. The latter stance may have been necessary to provide unity and tactical effectiveness for an outgunned minority, but it left a void. Americans expected to be offered the possibility of something better, rather than just less bad, for their future health.
The mounting difficulty of credibly accomplishing that goal will be even greater if and when the current legislation moves past its current cusp, but the political path ahead is not a one-way street. Exaggerated promises of greater “fairness” will collapse under the pressure and conflicts of zero-sum redistribution schemes. As healthcare markets are short-circuited and their posted price tags become even more distorted than before, the rules of engagement will change and make better paths not taken harder to find and steeper to climb.
So the prospects for changing course and achieving health policy reform that is more rational, effective, and (most of all) humble have regrettably moved further off into the future. But the self-appointed managers of hyper-politicized healthcare have taken ownership of a basket full of liabilities and toxic assets. Every complaint about the current healthcare system will be magnified by the deeper disappointment ahead over promises unfulfilled, problems compounded, and options foreclosed. Pushing through sweeping legislation despite a popular majority’s opposition is never a good career move for politicians.