Should the individual or government control healthcare?

While the president's town hall meeting before a joint session of Congress last night was eloquent, compromising and signaled the abandonment of the public option, let's not lose focus on the reality of what this president and Congress still face. In order to create bipartisan healthcare reform, it is instructive to examine the issues that are difficult or impossible to reach a consensus on and areas where there may be common ground between the two views.

Certain reforms will be difficult to agree on because there is no philosophical common ground between the liberal Democrats and conservative Republicans. The reforms that will be especially contentious and difficult to resolve include: a public single-payer healthcare option; raising taxes on individuals and businesses; limiting profits on insurance and pharmaceutical companies; rationing healthcare by government bureaucrats; subsidizing healthcare for illegal aliens; providing public funding for abortions; dictating insurance terms including equal individual premium costs for healthcare regardless of risk classifications of the insured such as gender, age, pre-existing conditions and healthy lifestyle (excepting smoking) of the insured; requiring universal coverage by businesses.

However, there are some reforms that both Republicans and Democrats may be able to agree upon. These areas are primarily marginal fixes to the current healthcare system and do not entail a major restructuring. Reforms where there may be common ground include: subsidizing low-income American citizens and legal aliens; requiring all Americans to have health insurance; reforming the medical malpractice tort system; permitting interstate competition among health insurers; ensuring portability of insurance; and promoting healthy lifestyles. Obviously, the devil will be in the details of crafting these reforms.

If the real issue of reform were to reduce the overall cost of medical care in America, the healthcare reform debate would center on reforming medical malpractice tort law (surprisingly, the president mentioned this in his speech), promoting healthy lifestyles and dealing with high end-of-life costs. Medical malpractice insurance and defensive medicine account for approximately 18 percent of healthcare costs. Obesity accounts for approximately 9 percent. Alcoholism and smoking account for another large percent. Approximately 40 percent of medical costs are incurred in the last six months of life. If the real issue was how to insure those American residents without insurance, the discussion would center on subsidies for the poor and the incentives required for other uninsured Americans to get insurance. However, the cost of medical care in America and covering the uninsured are not the real issue. The real issue is whether the individual or the government should control medical care.


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