Tuesday, August 11, 2009

Politics: A Health Care Mess

TORONTO, ONTARIO - In case you missed it, Nate Silver has one of the most amusing explanations of the difference between the Canadian and British health care systems I've ever seen. The only problem with making this distinction is that it isn't particularly relevant. As much as I personally might like a Canadian-style single-payer system, no current bill in Congress (of consequence, anyway) proposes one any more than they propose a British-style, government-run health care system. All are modifications of or additions to the existing privately-run health insurance systems.

As plenty of others have pointed out, the problem in trying to defend the attempt at health insurance reform in the United States is that there is no single proposal or even set of clearly leading proposals to defend. While a few things (like a government-run health care system, or a single-payer system) are clearly not in any bill, it really isn't clear what provisions will be in what passes through Congress. Thus, it is not possible to defend provisions--or even decide if the overall package is worth defending. At this point, it is possible that a bill that would genuinely improve the situation for most US citizens will emerge, but it is also possible that a really bad bill might emerge.

For reasons already discussed, the Obama administration has made the decision to let Congress write the health care legislation. In doing so, they have run into what New York Times columnist David Brooks warned about before the process started--that genuine health care reform could only take place after campaign finance reform, as otherwise special interests would ruin the process. About a month ago, Brooks expanded this idea to contrast "legislative pragmatism" with "policy pragmatism," making the case that trying to create legislation that would pass was at odds with creating policies that would actually work.

Perhaps much as Obama has tried to learn from the failure of the Clinton administration to pass health care reform, during this August recess his administration will come to see their own potential failure in favoring legislative pragmatism. If Obama rises above the current legislative mess, says something to the effect of "Congress did the ground work, but now it's time for me to build on their good work and present a bill we can all rally around," then perhaps a coherent, defensible bill that might pass will still emerge. However, that takes leadership from the White House that has yet to be seen in this administration. For the sake of actually improving the health care insurance system, instead of just expensive fiddling with it, I hope that happens.

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