Tuesday, July 28, 2009

Private vs. Public

If the reports coming out of the AP (via HuffPo) and the New York Times are to be believed, the public option may be in danger as the House and Senate tries to iron out a deal with recalcitrant conservative Democrats.

After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits two key Democratic priorities but incorporates provisions to slow the explosive rise in medical costs, officials said.

These officials said participants were on track to exclude a requirement many congressional Democrats seek for large businesses to offer coverage to their workers. Nor would there be a provision for a government insurance option, despite President Barack Obama’s support for such a plan.

Yeah, I know this is early in the process and hopefully when they go home for their August recess the senators and representatives will get an earful from the majority of people who clearly want something better than what they have right now. As Ezra Klein noted in his on-line chat yesterday, there’s a lot of mythology out there about health care.

We don’t have the best health care in the world. Not on any broad measure or metric. We don’t have the most cost effective health care in the world. We don’t have the best outcomes in the world. We can’t even manage to give everyone access to health care.

That said, there are certain diseases, like breast cancer, that we are uniquely good at treating. But then we lag on diseases like diabetes. It’s a mixed bag. And it’s a mixed bag that we are spending twice as much as most other countries on. So it’s important to say this clearly: We have a very, even uniquely, bad health-care system. Not for every individual. But in the aggregate. As a country, we spend far too much and get much too little.

Cutting costs is fine; it should be a priority. But so should making sure that health care is available for everyone, and that means more than just going to the emergency room.

What irritates me is that most, if not all, of this debate seems to be taking place in private and between about six or seven people on opposite sides of the debate. I’m not in favor of mob rule and I realize it’s not easy to deliberate and discuss the intricacies of the matter in front of the TV cameras — leave that to the likes Rep. John Boehner (R-OH), who spends so much time on camera that his unnatural tan must come from the kleig-lights — but a little transparency would be nice, especially if they’re going to drop something like the public option as if it was an extra order of fries.

I’m not taking for certain that what the House and Senate works out now will end up in the final bill; it rarely happens that way. Whether or not reality strikes the people who will make the laws that reform our system remains to be seen, but if the anecdotal evidence I’ve seen purely from the comments I got from one post asking about health care is any guide, people are ready for a lot more than just the status quo, so far we’re not seeing it, and as Paul Krugman noted yesterday, if what we get is what the Blue Dogs are offering, we’ll have gotten nowhere.