Health-care reform is complex


A commentary on the health care summit held on Feb 25:

To a person, Republicans followed a script: "Start over on a clean sheet of paper." They took the position that any change to the U.S. health care system must be "step by step" while also refusing to take seriously anything offered by Democrats.

By contrast, Democrats including the president argued that reform of so complex a system cannot be done one step at a time. They said that mending a broken system requires recognition of how parts of the system interconnect, necessitating a number of simultaneous changes.

The Democrats certainly have logic and reason on their side, to say nothing of their advantage in more effectively arguing on behalf of the needs and interests of all. But there is a still more comprehensive context for viewing defects of the U.S. health care delivery system. Within this larger context the Democrats, too, can be seen as pushing piecemeal reforms (though with more seriousness about change).

Obama made an early decision to define narrowly the scope of feasible change when he announced that he would not consider thoroughgoing change -- namely, enacting a single-payer system along the lines of what two dozen advanced Western countries have had for decades. His pragmatic reasoning here belies hot-headed rhetoric about his being one or another kind of radical.

The fact is that a great many Americans, including many doctors, see mainstream Democrats, too, taking a piecemeal approach to health-care reform. The result is a truncated debate which puts off-limits any consideration of two questions about reform:

(1) Why not unhitch health care financing completely from employment?

(2) Why must provision of health care be viewed as having anything to do with insurance? Why must probabilities associated with sickness and death be the basis for calculations about profit by insurance companies?

To take seriously these two questions could lead to the possibility of new ways to organize medical services and to finance costs of health care. There is a chance that, rather than a mandate requiring the young and/or healthy to buy "protection" from for-profit corporations, they (and others) would accept paying taxes dedicated to provision of health care for all. That acceptance would be more likely if health-care reform were also effectively to bring about a variety of cost controls and behavioral and systemic changes already being discussed.

Ray Norsworthy
Walla Walla


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