Saturday, June 13, 2009

Process vs. Content In Health Care Reform

Politics is a competitive activity with contests, winners, and losers. One consequence is that it tends to be more concerned with process than with content.

Nowhere is that more clear than in the current effort at the federal level to enact health care reform. The print pundits and the cable talking heads are giving little attention to the legislative provisions being considered and a great deal to questions like the effect of Senator Kennedy’s illness, how much of the detail should be left to the congress, and whether Senator Baucus will be able to persuade Senator Grassley to support a bill.

Although that approach works most of the time, I predict it will cause trouble in this case as it did with the Clinton effort in 1993. The health care issue is a lot more complicated than most people, including politicians, want to admit. In the Clinton case, the failure to recognize that resulted in a thousand-plus page report that proved too much for the Congress to digest. What form it will take in the current situation remains to be seen, but the unacknowledged complexity could well drag the process down again.

One indication is the amount of attention President Obama is trying to focus on the need to contain the cost of care while most of the proposals deal with health insurance, and do so in a way that would cost a ton of money. It doesn’t seem to have occurred to people that you don’t restrain cost by spending more money.

Another sign is the statement by Administration and Congressional leaders that health care reform must be “budget neutral” and not add to the deficit. They are a lot less specific about where the money would come from.

It looks to me as though the process of health care reform is once again going to be swamped by the content. We’ll see if I am right.

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