[Texgreen] How the health care battle will shape up

[Roger Baker]

<http://www.newyorker.com/talk/comment/=20
2007/07/23/070723taco_talk_gawande>


...Health care confronts us with a difficult test. We have never =20
corrected failure in something so deeply embedded in people=92s lives =20=

and in the economy without the pressure of an outright crisis. The =20
welfare reforms of 1996 made changes that profoundly affected =20
people=92s lives, but only those of the poor, which was why voters =20
supported the experiment. We adopted rules to protect clean water, =20
clean air, and endangered animal species, but the costs seemed small =20
and were largely hidden from taxpayers.

In the past few months, John Edwards and Barack Obama have put =20
forward coherent proposals to achieve universal or near-universal =20
coverage. For the first time in a decade and a half, the prospects =20
for reform seem genuinely promising. But the fight is about to begin. =20=

For example, Rudy Giuliani recently outlined a tax-credit-based =20
health plan that would come nowhere near covering everyone; for one =20
thing, he would let insurers continue to exclude people with =20
pre=EBxisting conditions. Its main purpose, it seems, is to let him =20
attack other proposals as involving a big government takeover of =20
medical care.

If, in 2009, we actually swear in a President committed to universal =20
health care, the fight will turn ugly. The plan most likely to gather =20=

broad support will look something like the Edwards/Obama approach, =20
which would subsidize health insurance for everyone who does not =20
receive coverage through work or through existing programs. It would =20
provide a choice of private insurance options, as in the Netherlands, =20=

and would probably add a Medicare-like government option as well. And =20=

it would require Americans to obtain coverage for, at a minimum, =20
their children.

People on the right will attack the plan as a tax-and-spend =20
nightmare, because it will have to include some mixture of increases =20
in business and personal-income taxes. And they=92ll say that it =20
dictates your medical choices and gives government too much control. =20
People on the left=97Moore included=97will attack the plan as a =20
boondoggle for insurance companies, because it isn=92t single-payer, =20
and will say that it gives government too little control. Others will =20=

attack it for what it does or doesn=92t do about malpractice =20
litigation, birth control, acupuncture, and so forth. The debate will =20=

become angry and murky and mind-numbingly complicated, and the =20
temptation will be to put off reform yet again.

That=92s exactly when you=92ll need to remind yourself of what=92s =
really =20
at stake. So if, in the throes of the debate, you find yourself =20
experiencing blurred vision, headache, and vertigo, here=92s a =20
prescription: go visit an emergency room, clotted with the uninsured, =20=

and see what=92s it like to try to get care. Or watch the movie. Either =20=

way, you=92ll be outraged again.=20=