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Health Care Reform at Crossroads

David Brooks, who just recently was telling us that health-care reform was a done deal, is dismayed. His focus today is on the absence of any coherent plan for reining in health-care costs. He argues that the current “comparative effectiveness research” proposal would fund research, “but negate the effects by allowing everybody to ignore the findings.” (Actually, ignoring the findings of bureaucrats trying to ration care is a good thing.) He also bemoans the apparent demise of a proposal to end the tax exemption on employer health benefits. (This development, without a corresponding tax credit for allowing people to buy their own insurance, is also a good thing.)

The public option plan they are considering, Brooks says won’t “really change the system.” And finally, he concludes, “Then there are all these mysterious deals the White House is cutting with industry groups. They sound good, but it’s not clear what the industry is getting in return, and they, too, would not alter the fundamental incentives.”

Now the real source of Brooks’s ire is that he wants higher taxes to help close the gaping deficit and doesn’t want all that tax revenue being used for health care:

To get our overall fiscal house in order, we’re going to need to raise taxes on the rich. The House bill would use that chit to pay for expanded coverage. We’re going to have to take a bite out of Medicare spending. The administration plan does that to pay for expanded coverage. We’re going to have to tax people in the middle class more. The Congressional bills effectively do that by mandating coverage and then failing to subsidize middle-class consumers. But that burden, too, is to pay for new coverage.

Instead of brightening the fiscal picture, these bills make it immeasurably worse.

Yes, massive, crippling taxes on every segment of society really shouldn’t be wasted on health care.

Well, there is plenty there for conservatives to disagree with. But despite the many differences conservatives would have with Brooks’s take, two central points he highlights would resonate with them. First, there is nothing in the Democrats’ plans that will actually address cost-containment, which — if one looks carefully at polling — is very high on the list of priorities for those who generally favor “reform.” And second, there is no agreement on how to pay for all of this.

There are, of course, ways to bring down health-care costs. Shifting from an employer-based to individually-purchased insurance and allowing interstate insurance sales will help. (Look at the car insurance market.) Real malpractice reform will help reduce unneeded tests and procedures that are the product of “defensive medicine.”

Reducing government mandates on health insurers (so that lower cost, basic-coverage plans can be more readily purchased by younger, healthier people) would also be a positive step. But these are antithetical to the Democrats’ vision of a one-size fits all, government-run health-care system. Thus Brooks is right on the big picture: if we want to reduce health-care costs, we should scrap everything coming out of Congress and start over again. Isn’t it about time to hit the reset button?



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