In the debate over health care reform, the big problem that I have noticed is that there is no agreement on what the goals of the reforms are. Some speak of reducing costs, others of expanding coverage, and other things have been brought in as well, such as making sure that people who are satisfied with their current coverage can maintain it (Pres. Obama claimed his plan would do this, but it quickly became clear that it will not if allowed to continue in the form in which it was enacted.) A goal that has never been explicitly stated is preserving the right to sue for malpractice, which is important to the trial lawyers who constitute a large portion of the Democratic Party's campaign funds, but is certainly responsible for the Democrats' opposition to Republican wishes to introduce tort reform. (In fact, except for labor unions, it would appear that the trial lawyers are the biggest source of funds for the Democrats.)
It would be easy, for example, to expand coverage to all Americans, by simply having the Government buy a health insurance policy for every person in the United States. But this would do nothing toward cost containment. And one could reduce costs by doing what the Cubans do: make all doctors employees of the Government, paid a salary that would be strictly controlled. (I read recently of a tourist in Havana who found that his taxi driver was a pediatrician who was making ends meet by driving a cab and giving guided tours! One could hardly imagine this in the USA, where a medical doctor — especially a specialist — is unlikely to need a second job!) But this solution, unless accompanied by some of the other Draconian aspects of a Communist dictatorship, would lead to a major exodus of people from the medical profession; hardly an acceptable outcome for anyone.
I think the problem is clearly that, in discussing health care reform, there are conflicting goals, and this is not being acknowledged by any of the actors in this debate: the Republicans or the Democrats; the trial lawyers, the insurance companies, or the medical doctors; the President or the various groups within the two Houses of Congress. And until these goals are prioritized, we will never be able to come up with a plan that will not prompt major screams of "foul!" from one or another side.
It would be easy, for example, to expand coverage to all Americans, by simply having the Government buy a health insurance policy for every person in the United States. But this would do nothing toward cost containment. And one could reduce costs by doing what the Cubans do: make all doctors employees of the Government, paid a salary that would be strictly controlled. (I read recently of a tourist in Havana who found that his taxi driver was a pediatrician who was making ends meet by driving a cab and giving guided tours! One could hardly imagine this in the USA, where a medical doctor — especially a specialist — is unlikely to need a second job!) But this solution, unless accompanied by some of the other Draconian aspects of a Communist dictatorship, would lead to a major exodus of people from the medical profession; hardly an acceptable outcome for anyone.
I think the problem is clearly that, in discussing health care reform, there are conflicting goals, and this is not being acknowledged by any of the actors in this debate: the Republicans or the Democrats; the trial lawyers, the insurance companies, or the medical doctors; the President or the various groups within the two Houses of Congress. And until these goals are prioritized, we will never be able to come up with a plan that will not prompt major screams of "foul!" from one or another side.
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