Words.
"President Obama set out a long list of worthy goals in his healthcare speech to Congress last week, but at least one of them was utterly unrealistic. "I am not the first president to take up this cause," he said, "but I am determined to be the last."
If Obama succeeds in winning a comprehensive healthcare bill, he will have established, for the first time, a federal government obligation to make some kind of health insurance available to every citizen. That's a monumental achievement.
But it will be only the first step in a process of designing, launching and improving a new healthcare system for a nation of some 300 million. That's a monumental task.
...Whatever bill gets through Congress this fall -- and it seems increasingly likely that one will -- is almost certain to obligate citizens to obtain insurance, require insurance companies to offer "affordable" basic policies and impose taxes and Medicare payment cuts to help pay the insurance bills of low-income families.
But no matter how specific the bill gets, it can't guarantee that the president's proposals for funding the plan will generate enough to cover the costs.
And the bill won't reshape the medical system to focus on overall care instead of individual procedures.
...Right now, the U.S. healthcare system is a patchwork of different systems -- Medicare for the elderly, Medicaid for the poor, military and veterans' medicine, private insurance for the fully employed, and a lot of cracks in between.
Decisions about how much to spend on health, and how, have often been made through backroom battles among big institutions: employers, insurance companies, drug companies and hospitals. Doctors and patients have been among the least influential players.
By expanding the federal role in healthcare, and by setting up a system that guarantees all citizens access to affordable insurance, Obama's plan gives everyone a stake in its success. Voters will want to know that this system is working well at a reasonable cost. They'll demand -- even more than they do now -- evidence that their money is being well spent. Future Congresses and presidents, far from being relieved of the issue, will find themselves debating it year after year. American medicine is being politicized -- and that may not be a bad thing."
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