Why neither standing pat nor retreating is a viable option
Quick take: The U.S. health care reform movement is fast arriving at a critical, "make or break" moment. Will the nation forge ahead with long overdue change to assure universal coverage, real cost containment, a fair financing system and real consumer choice or will it, once again, stick to business as usual? At such a time, Americans would do well to heed the example of some of their most courageous forebears of the last century.
At the risk of using an unusual analogy, it's safe to say that Americans are approaching a kind of modern D-Day in the battle to reform their health care system.
Sixty-five years ago last month, Allied troops landed on the beaches of Normandy with the goal of liberating Europe from Nazi oppression. In so doing, they began the final chapter in a long and terrible war. As most American schoolchildren have learned in the years since, the battle did not go well at first.
Invading troops in many areas encountered a persistent and murderous hail of bullets and shells that caused horrific casualties. Within the first few minutes of the invasion, survivors found themselves stuck on the beach with no viable retreat and few prospects for survival or rescue if they stayed where they were.
The only option, of course, was to advance.
Slowly – often independently and spontaneously – groups of Allied troops began to move forward. The process was messy and uneven and deadly, but ultimately, the invaders began to secure a foothold. In time, the beachhead was established and the invasion succeeded.
As we look back on the events of that momentous day, we marvel at the heroism of all involved and shudder at the thought of what might have happened if the landing had failed. It remains one of the most important days in American (and world history).
A modern policy parallel
Today, American supporters of health care reform seem to be confronting a kind of public policy D-Day of their own. Like their forefathers on the beaches of Normandy, those who would change the American health care system have arrived at a critical moment: a moment in which neither retreat nor staying in place is a viable option.
Right now, the American health care system is, in a word, broken. Huge swaths of our working population are uninsured and reliant upon hospital emergency rooms and/or charity care. In North Carolina, the number is around 1.8 million and rising fast, or roughly 20% of the population. Those lucky enough to remain insured find themselves paying more and more and growing less and less satisfied with the mind-boggling complexity of the current system. Like those men on the beach, we are stuck in an untenable situation.
The central cause of this predicament is as obvious as the Nazi bullets on that terrible morning in1944: The cost of health care (and thus of health care insurance) is out of control. As Dr. Uwe Reinhardt of Princeton University explained recently, Americans are paying unsustainable and rapidly growing percentages of their income on health care. At present rates, within the next decade, even an upper-middle class family will be paying more than 40% of its pre-tax income for health care. Like an out-of-control Ponzi scheme, the American health care system is redistributing so much personal income to the for-profit health care establishment (e.g. drug companies, insurance companies, specialty practices) that things simply cannot continue much longer. Employers, individuals – even state and federal governments – cannot afford it.
Retreat or advance?
Given the unsustainable nature of the current situation, Americans really face only two possible options: to retreat or advance. Should we scale back our efforts, head back to the boats and trust the "invisible hand" of the market to somehow make everything right (something that hasn't happened in any other nation) or should we move aggressively forward with real reform as so many other countries have done successfully?
As even a few moments of hard-headed reflection reveals, there is really no choice. Right now as you read this, the enemies of reform are bringing in "troop reinforcements" (in the form of, literally, hundreds of millions of dollars for lobbying, media ads and political campaign contributions) at an alarming rate. Their goal: To blunt the momentum in Congress for comprehensive reform so that the process slows to even more of a crawl than it already has.
As any veteran lobbyist knows well, delay is the time-honored practice for those playing political defense. Rather than confronting the reform train head on (last year's elections provided it with enormous momentum) the plan is to slow things down, make matters more complicated and, ultimately, kill reform with a thousand cuts.
Overlay this reality with the political opportunism gripping many anti-Obama conservatives (South Carolina Senator Jim DeMint recently stated that "If we're able to stop Obama on this, it will be his Waterloo. It will break him.") and you see the urgency of what confronts the reform movement.
At the heart of the issue
At this point, despite its deep complexity, the national health care reform debate really boils down to a few key issues. Here are four of them:
- The "public option" – Will reform allow consumers a choice under which they can choose their current plan (if they have one), another private plan or a public option? Polls show that the public wants such a choice overwhelmingly. The insurance industry (like Blue Cross Blue Shield of North Carolina), however, goes apoplectic at the notion of real competition that might rock its ultra-profitable world.
- Will the plan include real cost containment? If so, it will include strong incentives for greater patient involvement in health care decision making and reward quality primary care rather than maximizing the number of expensive, high tech procedures.
- Will the plan include a fair and progressive financing system that provides adequate funding, and that improves the overall fairness of the American tax system? As the respected Center on Budget and Policy Priorities pointed out late last week, the best bet on this front may be the plan from the U.S. House to enact a surcharge on the top 1.2% of all income earners.
- Finally, and most importantly is the plan universal? Does it, once and for all, address the national scandal that the current rate of uninsured Americans signifies or does it, as has been the pattern for so many decades, defer the hard decisions yet again.
Sixty-five years ago, in one of the finest moments in the nation's history, American soldiers resisted the temptation to bury their heads in the sand of the Normandy beaches. Today, the nation faces an analogous policy decision: Will we face up to and tackle the single greatest domestic policy challenge of the new century or will we cower on the ground and simply pray for the best? The next few weeks are likely to yield the answer to this question.