Monday, March 8, 2010

Health Care Reform as a No-Win Scenario

Last week David Brody posted an article at the Huffington Post on why health care reform is a lose-lose proposition for Democrats. He has a point. Politically there is just no good way from Democrats to deal with health care reform. They are literally dammed if they pass it and dammed if they don’t.

Health care reform is a seamless web. You simply can’t cut a hole in the web and put a new piece in it. We can’t just pass the parts of the health care reform package people want and not pass those parts of the package people don’t want. We either have total health care reform or no health care reform. There is no middle way nor has there ever been one.

We just can’t ban insurance company practices we don’t like. Insurance companies need these practices if they are to control costs. In order to make banning these practices palatable we must mandate universal converge. Otherwise people will have every incentive to not purchase health insurance until the really need it. But once we mandate universal purchase we must subsidize insurance coverage for those who cannot afford it. So a universal mandate must of necessity become a universal entitlement. Furthermore in order to control costs the government must play a significant role in regulating health insurance and even providing it. It is with universal entitlement and the expanded role of the state that health care reform becomes a no win scenario.

A large minority, indeed possible a majority, of the American people are against new universal entitlements. We can barely afford the ones we have. At some point deficit reduction must include entitlement reform. We do not reform entitlements by creating new ones. This is especially true if the new entitlement has virtually unlimited projected costs. Even worse this is a universal entitlement that increases the role of the government in health care. Many Americans like government even less than they like deficits. So those opposed to health insurance reform can campaign on the issue of entitlement and the expanded role of government and expect to receive good results at election time. And this is why so many Democrats in the House and Senate are reluctant to pass health care reform.

But without health care reform the cost of health insurance will continue to increase until only the very wealthy can afford it. Eventually health care will become a luxury like a Lamborghini or a 50,000 square foot mansion. This is our fate if we can’t control the cost of health care. And making it a universal entitlement provides the only way we can really control the cost of health care by the state. So the Democratic Party base is in favor of passing health care reform regardless of the consequences. As Blanche Lincoln has recently discovered the base of the Democratic Party can make life difficult for those it dislikes. That base clearly intends to dislike those Democrats who do not support health care reform. Democrats simply can’t win elections without the support of the base. But winning that support means supporting big government new entitlement health care reform.

So dammed if they do and dammed if they don’t. This is the Democrats dilemma on health care reform.

No comments: