A Modest Proposal

Democrats and Republicans seem rightly to agree that the top priority for health care reform is cost reduction. They disagree primarily over universal coverage. The nature and extent of the latter depend largely on the magnitude of the former. So, Mr. President, why not accept Republican incrementalism for now and force them to put up or shut up by concentrating, first, exclusively on cost containment--if successful, you become a hero, able to advocate more convincingly for the rest of your agenda; if unsuccessful, the rest of your agenda is moot, as it should be.

Abracadabra!

Speaker Pilosi boasted that the Democrats' version of health care reform eliminates a half-trillion dollars of waste, fraud, and abuse. If only saying it could make it so!

Off with their heads! (?)

Congress was in a snit over a Blue Cross subsidiary that announced a 39% rate hike. Rather than focusing (like a laser!) on the magnitude of the increase out of context, the irate regulators should have been more concerned about the company's medical loss ratio, the percentage of each premium dollar spent on paying claims (as opposed to administrative expenses and profit), in order to ensure some reasonable relationship between premium revenues and actuarial risks.

Unintended Consequences?

Central to the Republicans' counterproposal for health care cost-containment is tort reform--making malpractice suits more difficult to initiate and limiting punitive-damages awards. I agree that in our litigious society tort reform is needed, but who, besides the physicians, would benefit economically? In places where tort reform has been successfully implemented (California, Texas), have the physicians reduced their fees to reflect their reduced costs or simply used the savings from lower malpractice insurance premiums to augment their own incomes?

Mr. Fix-it

If a political candidate promises comprehensive solutions to any complex problem, vote for the other guy!

If a political candidate promises that he will pay for his programs by wringing the waste, fraud, and abuse from the system, vote for the other guy!

The president's marathon Health Care Reform Summit agreed in rare bipartisan fashion on the urgent need for cost-containment; but throughout the filibustering and puffery, I heard no mention whatsoever, from either side, of the single most impactful factor--physician practice behavior.

Unconstitutional?

If the United States Constitution is the definitive blueprint for democracy, how can it be, after more than 200 years, that preeminent American jurists still so often disagree on what it says?