Reforming health care will take time, comity

Posted: Friday, September 04, 2009

Over the summer, our nation has debated health care reform by participating in "town hall" meetings, writing to elected representatives and by talking about it with friends in a casual setting. Anyone who's followed the issue knows that people have strong views about health care reform, which begs the question: Are there right and wrong sides in this debate?

Advocates for significant, prompt changes to our health care system describe the status quo as being in crisis. To the thousands of Alaskans and millions of Americans without any health insurance, this is a fair description. Those with heath coverage have reasons to see things differently. Most Americans with health insurance enjoy it as a tax-free benefit of their jobs. Many, however, work at jobs that don't come with health insurance and others don't have jobs at all.

Some view it as those who choose not to work don't deserve a free ride from tax payers; it is absurd to argue that everyone who doesn't have a job doesn't want one. It is even more ridiculous to argue that people who work in jobs where the benefits don't include health care should just suck it up and deal with it.

It's fair to say then, at least from the perspective of those with no access to health care, that there is indeed a crisis. Those of us with health insurance may see it differently, but it's still not a desirable situation. Does anyone really want to live in a country where millions of people must pay out of pocket if they get sick, while others have a safety net? But acknowledging a crisis doesn't mean it can magically be fixed overnight.

If we can at least arrive at a consensus that there's a major problem in our health care system (crisis or not), the next step is to figure out the solution. Since President Obama took office he has urged Congress to answer this question, and the efforts to do so have produced a virulent backlash. Requests for a so-called "public option" have led to accusations of death panels and references to Nazis. Honestly, the complexity of finding a way to expand access to more, and perhaps someday all, Americans is daunting, but figuring out a solution to the problem doesn't require hyperbolic, vitriolic name calling.

If the downside to the American health care system is that it is available to too few people, the upside is that it is the best in the world for many of those who do have access to it. It would seem quite logical that if we are going to take our first-class pie and divide it among more people, then each person is going to get a smaller slice. The only way Canada and Europe manage to provide universal health coverage is by providing a lower-quality product to everyone.

I haven't gone to any "town hall" meetings this summer, but I did have a chance to listen to one of Sen. Mark Begich's aides at Thursday's Juneau Chamber of Commerce luncheon. Bruce Scandling did an able job of going over the good things that the Democrats in Congress and President Obama hope to achieve if a health care reform bill is passed this year. What I did not hear is what this is going to mean for average Americans who currently enjoy health insurance, and the options that come with it. While I decry those who call the president and his allies in Congress harsh names, I also think the only way to sell health care reform to this country is to be honest about its practical costs.

In addition to looking at Britain's National Health Service, we also can look at the Indian Health Service and the health care available to our nation's veterans as models of what a universal health care system might look like, and what it is like for the patients being treated in such systems. I think we all know that when health care is essentially free, there are longer waits for services and some procedures and medications are not on the list of available treatment options. While this is a diminution from what some of us have, it's a vast increase for many others.

At the end of the day, I believe that as a nation we will be better off morally and economically if we can have a meaningful debate about how to help more Americans receive the health care they need. This debate will require the people and our elected leaders to refrain from pointless negativity and to admit that sacrifices will have to be made by all of us for the good of the whole. Trying to implement change in the short-term is unrealistic, and anything rushed through now will have to be revisited and its mistakes fixed sooner rather than later.

It is more honest and productive to admit the enormity of the task and to debate possible solutions that can be phased in over a reasonable amount of time. This will allow for the inevitable process of trial and error despite over-optimistic promises that seem too good to be true.

• Ben Brown is an attorney living in Juneau and is the Juneau Republican Party chair.

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