Thursday, July 30, 2009

Why Health Care Reform Is So Hard

Those who wonder why health care reform has proved to be so difficult need not blame the pharmaceutical and health insurance lobbies, however powerful and self-serving they might be.

Instead, they need only read last Sunday’s New York Times (7/26/09). The Times devoted the full two page-length columns of its editorial section to a subject it titled Health Care Reform and You. But the last sentence of the first paragraph read “How does my family stand to benefit from health insurance reform?” thereby changing the subject from health care to health insurance. The rest of the editorial then focused on that topic.

As President Obama has pointed out repeatedly, the urgency of health care reform arises partly from high and rising cost that threatens the stability of the economy and the fiscal solvency of government and partly from issues relating to insurance, such as limitations of coverage and the uninsured, that involve moral considerations including tragedies for the individuals affected.

The two subjects are related.

Cost issues underlie some of the insurance problems. Denying or limiting coverage can result from attempts to contain costs. Some people don’t have health insurance because it costs too much and they either can’t afford it or don’t think it is worth it.

Almost all of the insurance remedies call for increased expenditures, which will cause costs to go up even further.

So a case can be made that the cost issue ought to be addressed first, with insurance remedies being considered after cost is brought under control. However, insurance matters are amenable to legislative remedies that are politically appealing while cost issues call for long-term efforts that are both thorny and painful and, therefore, politically hazardous.

A recent issue of The Boston Globe carried interviews on the subject of health care reform with several health leaders in the Boston area. One conclusion reached by the article was that the issues of cost and insurance coverage may be incompatible.

Small wonder that reform is proving so difficult to achieve.

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