What's Missing?

This is a picture of Aspen's health care panel, not pictured due to sloppy photography is Rep. Dianne DeGette (D-Colorado) who made some eloquent remarks about the failure of incremental reform in the congress. Incrementalism, she said, has been a "band-aid approach" which she then described (more like whack-a-mole) as simply causing new problems to appear in new areas in a way that makes structural problems worse. Under the circumstances, comprehensive reform is needed. What kind of reform? She didn't quite say other than that "everything must be on the table."

More to the point, her remark that what we need to do is "bring all the comprehensive and myriad interests in and begin to craft a package that will be portable, affordable, and universal" sums up why I'm not super-excited about the prospects for health care reform. After all, missing from the list of desiderata is improving public health. And I think that if we make our goal putting a package together that satisfies all the "comprehensive and myriad interests" then it's unlikely that we'll really get much in the way of improvement. Portable, affordable, and universal would be an improvement over the status quo but I think that even if it gets done people will wind up ultimately disappointed.

Comments

My congresswoman's name is Diana, not Dianne.

Posted by Joe | July 2, 2008 11:48 AM

Portable, affordable, and universal would be an improvement over the status quo but I think that even if it gets done people will wind up ultimately disappointed.

Matt: How could any legislation signed by President Obama possibly fail to disappoint some people? I mean, even if we were to enact France-style single payer, it's going to disappoint, you know, free market conservatives, or health insurance companies, or Mixner. I think any successful legislation that makes health insurance "portable, affordable" and truly "universal" would be an utterly vast improvement over the status quo.

After all, missing from the list of desiderata is improving public health.

What exactly are you talking about here? It seems to me we can continue to make improvements in "public health" even if we fail to enact whatever it is you feel constitutes the "perfect" health care legislation that wouldn't "disappoint" anybody. I mean, here our record as a nation is pretty mixed. Diabetes is exploding, for instance. But we've made great strides against smoking, and automobiles sure are a lot safer than once upon a time. I see no reason such improvements can't continue to be made no matter what happens on the reform front. Indeed public health is one area of health care in general where I think incrementalism is perfectly acceptable, and probably pretty inevitable. The decline in smoking, for instance, inevitably didn't take place over night.

Posted by Jasper | July 2, 2008 11:54 AM

I share Matt's concern. Comments like DeGette's make me suspect that deep down inside, the politicians themselves aren't really eager to launch comprehensive reform.

DeGette is right that the Band-Aid approach, though making the entire structure more inefficient and unstable, has created many inholdings for many different groups of people. But when she says that "everything must be on the table" in the effort to craft comprehensive reform, she's dispensing sound bite happy talk. Since no reform effort can possibly accomodate all the myriad interests, what she's proposing is something that would be doomed from the start, and she's been around DC long enough to know that.

Posted by Claudius | July 2, 2008 12:08 PM

black people?

You meant what's missing from the photograph, right?

Posted by beowulf | July 2, 2008 12:37 PM

Jasper,

Investments in broad public health programs and policies are likely to produce much larger improvements in the overall health and longevity of the population than extending "coverage" or "access" to expensive high-tech health care that produces relatively small benefits at high cost. That's one reason why the left's obsession with health "insurance" or "coverage" is so misplaced.

Posted by Mixner | July 2, 2008 1:36 PM

I just read where Ted Kennedy's people right now are working on a universal health care legislative package. I know nothing about the details. But here's the deal: I am imagining that Kennedy's people know he'll probably be dead within a year. So, the "liberal lion" who has always backed universal health care is "working on a package," then Obama is elected, Kennedy dies, and the Edward M. Kennedy Universal Health Care Act is passed to honor him.

It could help. This could be what is happening. We all gotta go sometime; could be Teddy's swan song.

Posted by Daddy Love | July 2, 2008 7:19 PM

So why hasn't she co-sponsored HR 676?

It's based on Medicare; it already has 86 cosponsors in the House; and it's ready to be worked on. Is that Kennedy's plan? I hope so.

And wishing on Kennedy's death just so UHC is passed? How... icky....

Physicians for a National Health Plan

Posted by cgeye | July 4, 2008 7:56 PM

Matthew- I think you are missing the point here ...the myriad of stakeholders that Rep. DeGette refers to includes public health interests. Anyone who is actually, truly involved in health reform knows that improved public health is inherent to a succcessful "portable, affordable, and universal" health care system.

Posted by public health-er | July 6, 2008 12:39 AM

Off the cuff I'd say women and anyone with a bit of color.

Posted by Riva | July 7, 2008 10:23 AM