Closing Arguments For and Against Health Care Reform

Health care reform is heading into what could be its do-or-die week. Democrats expect a vote by this weekend. Republicans are digging in. And op-ed writers are making their closing arguments.

Here's the Washington Post's Robert Samuelson taking on costs. Samuelson and I agree on the basics of reform: you can't bring down costs dramatically unless you change the fundamentals of our health providers and move away from a fee-for-service system. On every else, we don't see eye to eye.

First Samuelson questions the idea that universal health insurance is a worthy goal because universal care won't bring down emergency room visits. But that's far from the central justification for universal coverage. Let's leave aside questions of morality for a second. Health reform would force insurance companies to make their policies richer: no blocking customers with pre-existing conditions, community rating, no more rescinding insurance for health reasons. Richer policies could force up the price of insurance, because superior products are more expensive. But when the government forces tens of millions of younger, healthier Americans to buy health care, this gives insurance a larger pool of "cheaper" customers and brings down the cost. The universal mandate is a tool to bring down average premium prices.

Second Samuelson claims universal coverage is a fool's goal because health insurance doesn't actually make anybody healthier. He picks some controversial studies that support this argument, ignores studies that rebut his argument, and generally concludes that health care might be totally frivolous. But one paragraph later, we get this:

Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets.

Come. On. If Samuelson can spend four paragraphs arguing that insurance isn't necessary, why is he even worrying that uncontrolled spending prices people out of the market? That is, after all, just a fancy way of saying "makes people uninsured." And uninsured people are just as healthy as insured people. Because insurance doesn't matter, right?

I don't really know what to do with this. I want Samuelson to mention the delivery system reforms in the bill, if only to prove to me that he's aware of them. I want him to acknowledge the political challenge of instituting delivery system reforms as impending laws rather than pilot programs, if only to prove to me that he's thinking about politics and policy together. I want him to acknowledge that if the uninsured are capable of injury or disease, health insurance would help them; alternatively if they are, in fact, super-humanly healthy, then forcing them to buy insurance brings down the cost of insurance for the rest of us humans. Instead Samuelson has his eye trained on the perfect, and he's making it the enemy of good enough.