The health-care reform debate, re-imagined

Published On:
Wednesday, September 2, 2009
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Amidst the sturm und drang of the current health care debate, a quiet but significant consensus is building.

The wild emotionalism of the town hall protestors, the sudden squeamishness of moderate Democrats and the resulting frenzy of congressional liberals — all this stems from the same source: A dawning realization that no current plans are good ones, and that we cannot afford to mess this one up.

David Goldhill, in a cover story for The Atlantic’s September issue, adds a compelling voice to that growing consensus.

Goldhill’s argument — our health care payment system is too far removed from any rational market, serves the wrong consumer and creates perverse rewards — is not a new one. Where Goldhill’s treatment of the issue differs from previous ones is in its clarity and timeliness. For this critique, long-ignored by mainstream policy thinkers, to appear in a flagship magazine of American thought, signals that there is now a chance for real reform. Goldhill’s piece marshals the arguments for that reform impressively.

The facts are stark.

We spend too much. Eighteen percent of our GDP, says Goldhill, is spent on health care, and that share is growing. Of the economic growth since 2000, we’ve spent nearly a quarter of it on health care. Every employed person, he says, assuming costs grow no faster than earnings (an unlikely assumption), will spend together with his or her employer, $1.77 million on health care for a single family. Does that sound right?

Untethered from the logic of the market, the costs of medical procedures are vastly inflated. Indeed, we really have no way of knowing what even simple procedures should cost.

That inflation doesn’t exist in a vacuum. Even if you’re insured, even if your co-pay is reasonable, even if you can afford your coverage (for now), the excessive costs of medical care do have consequences. As Goldhill answers the belief that someone else will pay your bill, “there is no one else.”

The money simply isn’t there.

“Confiscating all the profits of all American companies, in every industry, wouldn’t cover even five months of our health-care expenses,” wrote Goldhill.

The president has often claimed the banner of “change.” But the health care proposals that have emerged from his Congress are nothing of the sort. Even if his best-case plan passes with resounding support to the applause of the health care intelligentsia, the same pathologies that have led us to this point will inevitably reappear.

To fix health care, we must start again. This fact is painfully clear, yet stunningly difficult in execution. Many will argue that such far-reaching change is unlikely to occur. And maybe they’re right. Maybe vitriol and gridlock are now constant features of our politics.

But maybe if we start over, we’ll discover that there are some things that Americans still agree on. Consumers can make rational choices.

Insurance should be for catastrophe, not everyday procedures. The current rate of spending will bankrupt us all.

Maybe a new system wouldn’t be drafted by “health care experts.”

But, with the labyrinthine workings of our current system laid open on the surgical table of reform, wouldn’t that be a good thing?

Reach Will at