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in 2009 there is no bigger issue

Summary for Healthcare Reform

Or as is politically popular these days, healthcare insurance reform.   What is a good summary of all of the arguments? 

The details of the House Bill, the only one Bill yet available, is dealt with elsewhere in this website.  To put it in perspective, a piece from Noonan seems to at least define the stag thus far: 

She writes"The big, complicated, obscure, abstruse, unsettling and ultimately unhelpful health-care plans, proposals and ideas keep rolling out of Washington. Five bills, thousands of pages, "as it says on page 346, paragraph 3, subsection D." No one knows what will be passed, what will make its way through House-Senate "conference." They don't even know what the president wants, what his true agenda is. He never seems to be leveling, only talking. Everything's open to misdirection and exaggeration, and everything, people fear, will come down to some future bureaucrat's interpretation of paragraph 3, subsection D, part 22.

What a disaster this health-care debate is. It strains, stresses and pierces, it unnecessarily agitates and is doomed to be the cause of further agitation. Who doubts the final bill will be something between a pig in a poke and three-card Monte?"

Healthcare reform is needed, so why so much dissension?  The simple overview of the issues could be:

  • First the difference of opinion on whether healthcare is a right or a service. 
  • The second issue is it a cost issue or a fundamental weakness in the structure of the healthcare industry. 
  • The third issue is government the best agent of change and should intervene in the market place or not. 
  • The fourth issue is the choice only between Obamacare and status quo.

The reader can think over the right vs. service question and there are several pages in this website to point out the distinctions and the conclusions that follow from a logical thought process.  It is a topic that seems isolated from daily political haranguing, and therefore can be decided separately.  it also makes the discussion and determination of the answers to the other questions much easier. 

This whole reform issue began as a focus on the uninsured and the raising costs of healthcare, if the reader can remember that far back.  Many things said during the campaign are now history and quite different than what is on the table.  What is is now is about insurance reform and the notion of pre-existing conditions as being bad somehow.  The notion of insurance reform is a good one, but have we lost track of the fact that the overall issue is cost? 

If it is a cost issue, then would not driving down costs as well bringing innovation to healthcare insurance and delivery going to serve the uninsured well?  If you study the uninsured breakdown, you can see that the chronically uninsured number currently about 10 million citizens, do suffer lower quality care.   To even buy them insurance would cost only a few tens of Billions of dollars, not the 100's that is the price of Obamacare, as forecasted by the CBO.  

So it must be that Obamacare will save money in the long run somehow.  So the second leg of the original goal can be achieved.  In fact it will raise the total cost of healthcare, for it services a larger demand with Medicare like procedures, until such time as the government limits the fee schedule or the total money spent.  This will be in the form of rationing as exists in Canada and England.  These countries and a highly rated country, France, were constructed in the 1940's. 

To transform our system as edited by the government would cause a lot of displacement and no doubt downward pressure on supply and quality, as well as huge reduction in R&D.   We and the world depend on us to develop the medical technology that has saved lives.  The risks to healthcare that come with Obamacare are many.  The government healthcare system, consuming nearly 50% of the total expenditure, does not deliver services or manage data well.   There is no precedent for any service that is better than a free market alternative.  There fore to assume the government is the desired agent of change in healthcare lacks any credence historically or logically.  

Could the government be a strong agent promoting the best changes?  Absolutely.  Drive conditions that bring about competition and there fore the best practices used in a broad way across the country.   These are all detailed in the Proposal Section.  Healthcare reform could take place over a multi-year project, guided by the President and carried out by Congress, with clear goals and objectives, such as insurance competition, tort reform, removing barriers to competition, and even providing coverage to the unisurad.  this could all be done without the huge deficits that come with Obamacare.