Obama was right to make health care his number 1.2 priority (along with propping up the financial system long enough for it to a) sort itself out or b) subject it to more responsible regulation (neither of which have occurred to date). I recognize that this flies in the face of conventional wisdom as proffered in the business and political punditry. Whatever.
But if you believe that the strength of the private sector, the preservation of jobs, and the control of the long term trajectory of the public debt at all levels are critical, then I would argue unequivocally that health care was and is the single most proactive strategic initiative that Obama could pursue.
First of all, let's knock off the premise on which the cognoscenti argue that health care should NOT have been at the top of Obama's list: namely, jobs. Ironically, both the left and the right criticize him for not making JOBS Job 1. The Left does this out of a mistaken philosophical notion that government must be the first responder to any crisis. The Right does it simply out of its capacity for infinite hypocrisy, recognizing that it similarly criticized Obama for the auto industry bailout which saved jobs and the financial industry bailout which was supposed to save jobs by securing the financial structure that is critical to job creation.
If we continue to embrace the Capitalist mythology that the private sector is and should be the primary engine of job creation (it would be nice), then neither Obama nor Bernanke are or should be responsible for creating jobs. It should be their job only in the last resort that the private sector has failed, which has become abundantly obvious. So, job creation logically should not have been Obama's highest priority at the time that he was pushing health care reform. It was not yet established beyond a reasonable doubt that the private sector could not or would not fulfill its theoretical role as 'first responder', which is inherently in its own enlightened self-interest because it is vital to its own survival.
What was clearly established at the time Obama took office, factually and logically if not politically, was that:
- health care costs were out of control;
- the private sector, both providers and corporate clients, were unable or unwilling to bring them under control;
- escalating costs were eroding jobs in the private sector and budgets in the public sector;
- transfer of costs and risks to families was eroding economic sustainability in family finances; and
- the health care platform, which is structurally dysfunctional to its core and in all its appendages, was creating an unsustainable paradigm in Medicare and Medicaid projecting out into the future, beginning yesterday.
To boot, health care is thirteen percent of the national economy, and affects directly or indirectly every other facet of the economy. Was it a priority? Was it not a single paradigm with multiple possibilities of positive outcome? Not according to much of our national public policy and punditry brain trust.
Obama's biggest failure in health care reform was not that he made it an early priority of his administration. His instincts were right. His execution was seriously flawed in two regards. First, he should have made the strategic importance of this clear to the American people, as he is now doing with jobs legislation. Second, he should not have delegated so much discretion to the numb-nuts in Congress in whom he vested responsibility for moving health care forward. Granted, Congress must craft and pass the ultimate law. But delegating leadership and communication as much as he did is the equivalent of Bush II delegating Osama Bin Laden's removal from Tora Bora to our newest best friends in Afghanistan. Not one of his ten best calls.
Happily, all is not lost. The revelation this week that health care costs have risen 9% in the past year, and that employers and insurance intermediaries are once again passing more of the costs and risk onto individuals and families should refresh everyone's awareness of the dilemma. If this does not re-ignite the call for reform and, yes, a single payer system, I don't know what will.
* * *
This gets us to a separate but related issue: the 'individual mandate' for health coverage. If ever there was a classic example of Republican hypocrisy and twisted logic, it is their opposition to the individual mandate.
Here we have the same folks who would push citizens into 'privatized' social security accounts, and we've seen how well that might have worked for them in the past six years. They have mandated a prescription drug coverage which forces seniors to choose private sector programs. Apparently no problem there for what is a microcosm of the larger individual mandate. Then there's the libertarian wing which calls on individual responsibility. The 'individual mandate' forces individual responsibility, even among individuals who might be able to afford it but lack the sense of responsibility to be responsible, at the possible cost to their families and society.
It seems self-evident that if the states can mandate insurance coverage for drivers, and if the Feds can impose an income tax and a military draft and regulate one's movement in and out of the country, then it can mandate that the individual assume some level of personal responsibility for the factor most directly connected to his or her own well-being and capacity to enjoy any measure of independence and prosperity--health. The mechanics of that can be debated; the underlying principle should be beyond dispute. We shall see.
I've long believed that employers should be out of the health care equation. Increase workers' income by the equivalent amount the employer would otherwise pay for benefits, and then let employees make their own arrangements. In the matter of health care, employers' and employees' priorities are not aligned. Employers are more concerned about cost than employee health; employees are concerned more about health, and will care more about cost when they have more control over choice and greater awareness of the total cost. There is little point in pretending otherwise. The logic of group health benefits, from both employer and employee perspectives, has long been eroded by economic reality. It is time to euthanize this cancer on our economic and social well-being and allow a sustainable replacement to be born.
Onward
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