Responsible Adults Needed On Health Care

David Brooks is on a roll lately. His editorial “The Baucus Conundrum” succinctly summarizes the harsh realities of the health care debate – both the fundamental kinds of reform needed to the system and the clear reality that Congress is moving in exactly the wrong direction in their fundamental approach to the issue.

Brooks is absolutely right when he suggest that:

[the health care] system needs fundamental reform. We need to transition away from a fee-for-service system to one that directs incentives toward better care, not more procedures. We need to move away from the employer-based system, which is eroding year by year. We need to move toward a more transparent system, in which people see the consequences of their choices.

After summarizing good ways the country could get to fundamental reform that encourages transparency, innovation, consumer responsibility and free choice. He also summarizes the fundamental problems with the emerging congressional legislation well:

The real health care choice now is between the status quo and the bill primarily authored by Senator Max Baucus, Democrat of Montana, that is emerging from the Senate Finance Committee.

The Baucus bill centralizes power, in contrast to the free choice approach, which decentralizes it. ……..

It entrenches a flawed system. It creates greater uniformity and rigidity. It redistributes income from the politically disorganized young to the politically organized old. It squeezes people into a Rube Goldberg complex of bureaucracies based on their income level. It will impose huge costs on people as they rise up the income ladder, distorting the whole economy.

The biggest problem is that it will retard innovation. Top-down systems just don’t innovate well, no matter how many Innovation Centers you put in the Department of Health and Human Services. The bill will retard innovation by using monopoly power to squeeze costs. It will also retard innovation by directing resources toward current care (and current voters) and away from future technologies and future beneficiaries.

In the end, Brooks suggests that we do not have a realistic political option of anything rational and sensible, like the bill proposed by Senator Wyden or the kind of real solutions proposed by Whole Foods CEO John Mackey, Harvard Medical School Dean Jeffrey Flier or Atlantic Monthly contributor David Goldhill. He suggests:

At this point people like me could throw up our hands and oppose everything. But that’s not what adulthood is about. In the real world, you often don’t get to choose what your options will be. You have to choose from a few bad options.

He concludes his essay suggesting:

If I were in Congress, I’d figure there’s an 80 percent chance of something like this passing anyway. I might as well get engaged as a provisional supporter to fight to make it better, or at least to fight off the coming onslaught to make it worse.

With that kind of “realistic adult attitude” dominating the political debate in support of policies moving in exactly the wrong direction and doomed to inevitable wasteful failure on major issues like health care and energy,  I am reminded of the “realistic adults” in the Kremlin debating Soviet five year plans in 1988.

It would actually be far more responsible for American citizens to get realistic about the complete failure of our congressional “leaders” from both parties. Its well past time to start throwing them all out if these are the best kinds of solutions that they are able to come up with.

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