Llewellyn

King

Read Llewellyn's bio and previous columns

July 30, 2009

The Health Care Fix That Dare Not Speak Its Name

Workaround is a made-up word that came to us from the computer industry – at least, that is how it came into general usage. In that industry, a workaround can be a crafty piece of engineering to get the results you want without infringing on someone else’s patent.

Watching President Barack Obama at last week’s prime-time news conference, one had the feeling that he was engaged in a workaround. He was selling a vague health care reform proposal. His spiel was very long because he was selling something that is still a work in progress. Worse: Whatever Obama gets is not going to be the real thing. It is going to be a workaround.

One has the feeling that congressional pusillanimity has the Democrats and their leader working around what at heart they know is the only solution to the challenge of health care – a strong federal role. Call it the solution that dare not speak its name, like Oscar Wilde’s love.

One had the feeling in the East Room last week that the president wanted to lay down the burden of political gamesmanship and say, “National systems work from Taiwan to Norway, Canada to Australia; why, oh why can’t we face this reality?”

The first answer is that no one has the courage to face the Banshee wails of “socialism” that already echo from the right and would intensify to the sound of a Category 3 hurricane. Politically, it would be seen as a bridge too far. Had Obama said in the presidential campaign that he was for a single-payer option, the Democrats on Capitol Hill might have had the temerity to investigate what works remarkably well in Belgium and Japan, among dozens of other countries.

Globally, the single-payer option – or, let’s face it, nationalization – has brought in universal coverage at about half of what the United States spends today; let alone what we will spend with the clumsy hybrid that the president is selling and Congress is concocting.

Under nearly all state-operated systems, private insurers have a role. My friends in Britain and Ireland all have private insurance for bespoke medicine above that available on the state system. Sure, state systems are criticized, especially in Italy (along with everything else), but not one country that has a state system has made any political move to repeal it. State systems are popular.

In Britain, where I have had most experience with the National Health Service, it is the third rail of their politics. Even the great advocate of free enterprise, Margaret Thatcher, did not dare to even think of touching it. Every British Tory wants to make it more efficient, but none wants to repeal it. Thatcher repealed anything that had the whiff of socialism about it and privatized much, including the railways, but the health system was sacrosanct.

The issue should not be whether we can keep every insurer alive and whether we should continue to burden employers with the health care of their staffs and their families, but whether a new system will deliver for all Americans at reasonable cost.

It is probably too late to rationalize the system all at once. There are too many interests, too much money at stake and a pathological fear of government, fanned by the loud few. No matter that the Tennessee Valley Authority works well, that the Veterans Administration is a larger, and probably better, state program than those in many countries.

It is not just in health care that Congress and the administration are engaged in workaround. Cap-and-trade in energy is another piece of avoidance. Utility chief, after utility chief, after utility chief – among them, John Rowe of Exelon and James Rogers of Duke – has said that a simple carbon tax would be more effective and cheaper than cap-and-trade. But the same people who yell “socialist” get severe arrhythmia at the mention of “tax.” Workaround.

© 2009 North Star Writers Group. May not be republished without permission.

Click here to talk to our writers and editors about this column and others in our discussion forum.

To e-mail feedback about this column, click here. If you enjoy this writer's work, please contact your local newspapers editors and ask them to carry it.

This is Column # LK104. Request permission to publish here.