Congress: Incapable of Handling Health Care Reform

A recent op ed in the NY Times by Donald L. Barlett and James Steele cite a World Health Organization statistic that ranks the U.S. as 29th in terms of life expectancy measured in healthy years. According to Barlett and Steele, the explanation for what they call our "abysmal record" is the profit driven nature of the system. While the market functions well in delivering consumer products it does not work well in providing health care, where the goal cannot, and should not, be the increased sale of heart bypass operations as if they were a new brand of breakfast cereal.

The money, however, is in treatment - not prevention - so the market and good health care are at odds. Just how at odds is seen in the current shortage of flu vaccine. Preventing a flu epidemic that could kill 1,000s is not nearly as profitable as the manufacture of viagra, which brings in more than 1 billion a year for Pfizer.

What type of remedy do Barlett and Steele recommend for our ailing system? An independent agency that would set national health care policy, collect fees, pay claims, reimburse doctors fairly and restrain runaway drug prices - in a word - a single payer system such as already exists for Medicare.

The chance of getting such a program passed by Congress? Absolutely nil.

As Daniel Lazare makes clear in The Frozen Republic: How The Constitution is Paralyzing Democracy, Congress entirely lacks the competence to take on a fundamental issue like health care. In the late 1940's, Britain's Labor government created the National Health Service with a handful of civil servants and occasional input from the British Medical Association. By contrast, in 1993, Clinton's point man on health care, Ira Magaziner, recruited more than 500 experts to examine everything from cost controls to ethics. A Canadian style single payer system would have been far simpler but also more disturbing to the status quo, which was why Clinton opposed it. Instead, he opted for a complex approach that Republicans and powerful health care "industry" interests found easy to ridicule into oblivion.

Democratic senators quickly began peeling away to formulate their own proposals so that before long there were half a dozen plans circulating on Capitol Hill, each more complicated and flawed than the next. In the end, the whole game collapsed due to general exhaustion.

In the 11 years since the 1993 health care debacle, the problem has only gotten worse. We are in another presidential campaign season and health care is again on the agenda. Kerry's plan, to allow the general citizenry to opt into the federal employees health care program harkens back to simplicity. But, will it be a simple matter to get his program through a Congress where one or both Houses will be controlled by the opposition? Can Kerry even count on a majority in his own party to support him?

Every advanced industrial nation managed to create a comprehensive health care system decades ago with far less fuss and bother. We need to begin to look at the structure of our political institutions for an answer as to why the U.S. has been unable to do the same.