Sunday, February 28, 2010

An Alternative to Kicking the Can Down the Road

One possible good outcome of President Barack Obama’s recent very public exercises in politics is that they may box him into a political corner — a corner in which he is forced to something far more practical he would naturally tend to do.

On the subject of health care, it was folly to try to undertake health care reform without addressing the subject of cost savings. This was the same mistake that Hillary Clinton made more than a decade earlier. Both proposals, in their various forms, would have restructured the health coverage process to make it more inclusive, but would have deferred the subject of cost savings for later — “kicking the can down the road,” something Obama said must not be done, even as he proceeded to do it.

If Congress had started with the more modest task of creating a public health coverage mechanism for federal government employees, it could have been done by now, and the federal budget could be enjoying perhaps $30 billion in cost savings in the current fiscal year. This sounds like only a tiny piece of the puzzle, until you remember how many civilian federal employees there are; it would be much more than a token change. Then, with cost savings generated and demonstrated, it would not be so hard to expand the program in one direction or another. I do not always advocate such an incremental approach, but taking small steps now is almost always preferred to large steps that must be delayed for five to ten years.

Until the costs of health coverage are properly addressed, the federal budget will never balance, so this is a subject that will not go away. Congress will have to consider alternatives to contain health care costs in the new budget, and I hope they will consider something practical that will allow some group of health care consumers — it scarcely matters where they start — to escape the morass of paperwork and fraud that the private health insurance system has become.