Right on Health ReformCan we afford to stay with the current [health-care] system?" It's the question that stood out in the speech. In his address before Congress, the president acknowledged the system's incredible expense, calling it "the costliest on earth"; he mentioned that there are great inefficiencies and, worse, millions lacking insurance altogether; and he tied economic recovery to health reform, particularly by noting the challenges businesses face in affording coverage for their employees.
Three things those skeptical of government health care should keep in mind in the coming weeks.
National Review Online
February 27, 2009
The speech—a presidential call to arms, urging swift congressional action to create a massive new entitlement—seems so familiar and recent. But those words come from 1993, and the speaker was William Jefferson Clinton.
As was true of his predecessor, when President Obama spoke this week, his strongest words were saved for health reform. Also like Clinton, he focused on the many problems with the system. He hit home on issue’s urgency: "It will not wait another year."
But if there are similarities in the speeches, there is good reason to believe that President Obama's efforts will end very differently. This isn't 1993. Then, Republicans faced a president who had won office with 43 percent of the vote; President Obama crushed McCain. For the crucial work of championing health-care reform, Clinton chose his passionate but inexperienced wife; this White House has assembled a fine team of seasoned players.
Perhaps more important, the mood now favors health reform. Americans have grown exhausted of the high expenses. The calls for change come from everywhere—corporate boardrooms and union halls alike.
President Obama has promised comprehensive health reform in the coming weeks. Though budget details are still emerging, this much is already clear: The administration envisions massive new health spending, and a new role for Washington. The question for those of us hesitant on government-run health care is simple: What now? Here are three things we need to do.
First, draw a line in the sand. If there is any lesson to be learned from the economic-stimulus package, it's this: A few votes count. The key for Republicans will be to make those votes actually amount to something more than trimming at the edges.
Where to fight? Democrats have touted the idea of allowing people the option of a new public program to compete with existing private insurance plans. The problem is that public programs have a competitive advantage over private plans: They employ wage and price controls. A physician treating an elderly man on Medicare gets paid a fraction of what he does for treating that patient's privately covered son. (Providers tolerate this because they can make their money through the higher private-insurance reimbursements—in a sense, the private sector subsidizes the public insurance.)
If we allow people the option between Medicare for All and their usual private plans, many will opt for the government program. With swelling enrollment for public health care, President Obama can engineer quickly and easily what Mrs. Clinton could not a decade and a half ago: an orderly transition to government-run health care.
Republicans can compromise on some things; they can't allow new public programs for everyone.
Second, remind Americans of why we care. No one would deny that America's health-care system is unsatisfying. But acknowledging the obvious doesn't necessarily mean that a sweeping White House plan is the right approach. Democrats may care about this issue, but their passion blinds them: They understate the deep problems with Medicaid and Medicare; they are eager to embrace expensive new entitlements; they dismiss the incredible shortcomings of socialized medicine in countries like Canada.
Americans deserve a better system. That means that we need reform, but it also means we can't settle for the rationing of care seen in the rest of the developed world.
Third, provide alternatives. Americans want solutions, not just criticisms. We need to point Americans to the road less traveled in health reform: individual choice and competition. It's possible to allow the unemployed and the self-employed more options in health insurance, not by expanding Washington's reach, but by allowing people to purchase health plans across state lines. We favor better quality of care, not through the creation of a government committee, but by empowering patients with better information.
Ultimately, we want people to own their health insurance—and favor tax reforms to make that happen.
In his speech, President Obama noted that Theodore Roosevelt called for reform nearly a century ago. Roosevelt never shied away from a good fight; he was comfortable challenging vested interests and Washington politicians. Today's Republicans and their allies need to do the same. American medicine depends on it.
David Gratzer, a physician, is a senior fellow at the Manhattan Institute.