Our illusions about health care

By Dennis Byrne
Chicago Tribune

If Sen. Edward Kennedy's 651-page bill reconstructing America's health-care system is any indication, the next few weeks will be confusing and exasperating.

Immodestly speaking, the Massachusetts Democrat thinks the government can bestow on Americans long-term care insurance for a far-fetched $65 a month. Right there is a great example of what the approaching weeks will be like as Congress opens debate on every utopian and fly-by-night idea for creating a perfectly healthy society, for a lot less than we're paying now. If there's ever a time for Americans to be skeptical, it's now, because the stakes may never be this high again.

What some are proposing to do with health care is akin to trying to take apart a wheezing old diesel engine and then, by adding a few new parts and a lot of stargazing, turn it into a jet aircraft engine. It has all the earmarks of President Barack Obama's fantasy that everything can be upgraded to excellent, if not perfect, condition in a few weeks by blindly blowing hundreds of billions of dollars out the door.

As a wise professor of mine once said, when you want to create or change public policy, what exactly are you trying to do? You've got to bore through the rhetoric, dogma and politics to find the heart of it. Do you, for example, want to insure every American for the sake of insuring every American, or is the goal to improve every American's health?

We keep hearing that we must provide medical coverage for what the Bureau of the Census says are approximately 47 million uninsured Americans, but there's no discussion of whether that's the goal itself, or a means to the goal.

It's made more difficult because the Census Bureau's survey doesn't delve deeply into why 47 million are uninsured: Because they're young and healthy and don't want to be covered? Because they can't afford it? Because of a disqualifying prior medical condition? No doubt, for all those reasons, but in what proportions? Also ignored is what proportion of the uninsured is nonetheless receiving health care through Medicaid or the State Children's Health Insurance Program. (By the way, the same annual survey shows that the number and percentage of uninsured children continues to decline.)

If you can't answer those questions with precision, you can't design a program that will do what the ultimate goal is -- better health care for all Americans, regardless of whether it is through an insurance program or some other way. For example, if 10 percent of the 47 million are young and healthy and don't want to be insured, forcing them all to buy a policy isn't going to do much to finance the new system. If 10 percent of the 47 million are involuntarily uninsured, then the problem isn't as bad as it is described, so we can ask: Why are we rebuilding the whole system?

Gets complicated doesn't it? Perhaps such questions will soon be answered with clarity. But my hopes aren't high because these kinds of questions have been persistently ignored in the health-care debate.