The most misused word in the health-care debate is "reform." Everyone wants reform, but what constitutes reform is another matter. If you listen to President Obama, his reform will satisfy almost everyone. It will insure the uninsured, control runaway health spending, subdue future budget deficits, preserve choice for patients, and improve quality of care. These claims are self-serving exaggerations and political fantasies. They have destroyed what should be a serious national discussion of health care.
The health-care conundrum involves a contradiction that the administration steadfastly obscures: in the short run—meaning four to eight years—government cannot both insure the uninsured and rein in health spending. Here's why. The notion that the uninsured get little or no care is a myth: they now receive about 50 to 70 percent of the health care of the insured. If they become insured, their health spending would rise toward 100 percent; that would increase both government and private health costs, depending on how the insurance is provided.
Until health spending is better controlled, expanding insurance coverage will be expensive. The president talks endlessly about the need to curb spending and eliminate waste. These are worthy goals. But changing the way medical care is delivered and paid for would take years and involve disruptive and unpopular measures. Patient copayments might increase; networks of doctors and hospitals might displace individual practices; the tax exclusion for employer-paid health insurance might be curbed. Obama downplays the obstacles. In practice, any reform isn't likely to compel needed changes, in part because it's not always clear what will work.
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