Wednesday, September 30, 2009
Historically, health care in the United states has always been highly decentralized and forged on the basis of political action committees and paid lobbyists that represent specific groups: Medicare (the elderly), Medicaid (the poor, ) Children's Health Insurance Program (children), Veterans Health Administration (veterans), the Indian Health Service (native Americans), and Federal Employees Health Benefits Program (federal employees). Others are covered by employment-based private health insurance. All of these programs are tax-supported to various degrees. And all of them are either running deficits, infested with fraud, inefficiency, or a combination of all three. Despite shortcomings, these programs are also highly coveted by their respective constituencies, and therefore no one in Congress can reasonably propose replacing this patchwork with a single system. In other words, the health care reform movement in the United States is not about creating one single system, but rather adding other programs to that patchwork. The powerless constituencies that are currently left out this patchwork include: employees whose employers do not offer health insurance, patients with pre-existing medical conditions, employees that are under-insured (but don’t know it yet), and an undetermined number of young, healthy employees that choose to forego purchasing health insurance. Whatever happens under the guise of health care reform, I can promise you that none of the current programs will be eliminated. In other words, whatever it is that’s taking place in Washington under the guise of “Health Care Reform,” it is really about maintaining the status quo. At this point, there is no reason to debate the question of whether a centralized system is preferable to a decentralized one. That’s because no one in congress is really pushing for a centralized system. What's the problem? It's the way we go about forging public policy in the United States. Can we really afford to continue to allow Congress unlimited access to tax dollars and dole out political favors to powerful groups represented by well-paid lobbyists?