My turn: Health care debate picks up pace, shows progress

Posted: Friday, September 18, 2009

Over the past few weeks, the conversation about fundamentally changing our nation's health-care delivery system has continued, indeed it has picked up pace. After a summer of intense debate, with raised voices at town hall meetings and competing claims about what reform might mean exploding from the media, Congress returned to Washington to take up this extremely important issue. The eyes and ears of America were on President Obama as he addressed Congress last week. While I don't think there's a solution right around the corner, I think progress is being made and I commend our elected leaders for their efforts.

The fears of those who don't want government involved in their health care cannot be dismissed as unreasonable, but neither can the hopes of those who currently don't have access to needed medical services. Both sides have a right to be heard, and at the end of the day, we as a country ought to try to find a solution that does as much good for the greatest number of people and the least amount of harm to any.

People ask, how can the United States produce the best quality health care if it is unavailable to millions of Americans? The question is illogical. Quality and access are different things. Indeed, the production of many luxury goods is possible only because they are made in limited quantities. The amazing pharmaceutical products produced by American firms are made possible in part by public dollars underwriting the research and development process. But a far larger incentive for private-sector firms to seek out medicines that produce miraculous results is the economic reward for creating these products. Because there are such a large number of Americans who have decent health insurance - coverage that will pay for part if not all the costs of expensive drugs - the firms that make these cures allocate vast resources to create and perfect them. These businesses then try to keep selling their wonderful products at the highest possible rates for as long as possible to the widest possible market in order to obtain a return on their investment. This is rational economic behavior, but is it good policy?

The problem with expanding access to the types of top-drawer medical products exemplified by the best American pharmaceuticals is that those to whom access is to be expanded won't be able to pay for the products. And with the passage of time, many who can currently pay for them may find themselves unable to do so in the future.

In order to provide health care to those who currently have none, we're going to have to scale back what we're offering to this group, and we have to be honest about the real likelihood that many who have something now are going to have to get by with a little less in future. This fundamental truth still remains unspoken in the health-care reform debate.

The Senate Finance Committee just this week unveiled its so-called compromise bill, which currently has no Republican supporters. This bill has no "public option" and President Obama has conceded that the lack of such a provision will not prevent him from supporting it.

Our elected leaders are slowly coming around to the realization that health insurance may not be an effective or efficient way to deliver health care universally. It is pretty obvious that there are no economic incentives in most health insurance plans to live more healthfully. Those who smoke or eat lots of unhealthy foods generally don't pay higher premiums. Conversely, those who exercise regularly and carefully maintain healthy diets are not rewarded monetarily. The rewards for these choices instead take the form of longer life spans and healthier (which possibly means happier) existences.

Real health-care reform must find a way at least partly to internalize the costs of both good and bad choices. Otherwise, costs will never be effectively contained, and the goals of maintaining what people currently have, let alone expanding access to a currently unserved population, will be elusive if not impossible.

There is a wide gulf between altruistic amorphous support for expanding access to health care and vehement opposition to any sort of expanded government involvement in this sector of our economy. When faced with the unknown consequences of trying to do the right thing, it is understandable that people prefer the status quo, even when they're rightly told that the way we do things now is patently unsustainable.

In order to obtain bipartisan and broad public support for any health-care bill this year, President Obama and the congressional leadership must be honest about the real costs and benefits of what they propose to do in comparison to doing nothing. This may require what public-option and universal-care advocates consider to be an incomplete or piecemeal solution, but in the end some sort of incremental approach may be the only way to progress toward a long-term solution.

• Ben Brown is a lifelong Alaskan living in Juneau.

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