Rx: Real Reform
In his epic distillation of the wrongheadedness of the U.S. health care system (Time, 3/4/2013), Steven Brill asks a simple question: Why is health care so expensive? What Mr. Brill discovers is old news to those who have closely followed the decades-long debate over health care reform, but the numbers he uncovers retain the power to shock. In his forensic accounting, Mr. Brill discovers jaw-dropping mark-ups at every stage of health care delivery. The gouging is rampant at both for-profit and allegedly not-for-profit facilities, where in a white-collar gold rush, some executives reward themselves with million dollar—and beyond—salaries.
U.S. health care now consumes as much as 20 percent of the nation’s economy. Yet despite its high cost—as much as triple the per capita expense of other industrialized nations—it still achieves only poor to mediocre outcomes.
It is clear who benefits from the status quo, but who pays? U.S. taxpayers and health plan members, many of whom surrender each year a percentage of compensation that represents the difference between working for want and a reasonably secure middle-class lifestyle. About the only dependable players in this carnival of overbilling have been much-derided government bureaucrats striving to keep hospital invoices honest in the nation’s vast Medicare system. So why has a greatly expanded Medicare, the so-called public option, been tabled in discussions of health care reform?
Mr. Brill explains that however sensible it may be, the public option creates too many “losers” among people in health care with clout in Washington. The cloutless outside the Beltway, however, deserve better treatment. Allowing industry lobbyists to continue to dictate the parameters of “reform” is a prescription for disaster.
The confluence of the papal conclave and the resignation of Cardinal Keith O’Brien of Scotland focused the media’s attention on celibacy. Cardinal O’Brien was accused by several priests of making inappropriate sexual advances; soon afterward he resigned, turned down a chance to attend the conclave and then issued an apology. For a few in the media (not all, of course) this was an opportunity to opine on something that some opinion-makers seem to know little about: the celibate life. Priests are lonely, said several op-eds; and celibacy was said (against all the evidence) to be a direct cause of sexual abuse.
Some op-ed articles seem to have been written by people who have never met a priest who has promised celibacy or a member of a religious order who vows chastity. (That the two—celibacy and chastity—are different also eludes many commentators.) There are, of course, fewer celibate men and women around these days in the clergy and religious orders. But it rarely seems to dawn on some essayists that they already know many celibate people—unmarried men and women, widows and widowers, for example—who are not child molesters. Second, it seems impossible to them that someone could forego sexual intimacy and not be either sick or crazy and certainly lonely. Yet a survey by the Center for Applied Research in the Apostolate in 2009 showed that a staggering 97 percent of priests (that would be celibate priests) are “very happy” or “pretty happy”—two thirds of them being “very happy.” Celibacy and loneliness rank relatively low as “problems” for them. High among “sources of satisfaction” was the “opportunity to work with many people and be part of their lives.”
The nation was treated to the mother of all Beltway paralyses on March 1 with the beginning of sequestration. A doomsday tactic that had been cobbled together as a prod toward rational compromise grew into the monster that consumed the 2013 budget, as $85 billion in defense and social spending cuts began. Worse, as sequestration ticked closer in February, some politicians began to promote it to the public as a more or less harmless way to get Washing-ton spending under control.
But as it takes effect over the coming months, sequestration will begin inflicting real pain on people least able to endure it. While the nation’s scandalous defense spending has long required sensible reduction, many Americans still suffering in the aftermath of the Great Recession need government support now. Some vital programs that serve the most vulnerable, like nutrition aid and health services, will be protected. But other programs—housing vouchers for the poor and disabled, for example—will suffer more from the cutbacks.
If common sense prevails, there remains negotiating room this year to put the country on a path to sensible spending control, measuring the special demands of the economic moment against the long-term requirement of deficit reduction. Are this White House and this Congress up to that challenge? The current rhetoric suggests otherwise. The public may have to wait until the next round of congressional elections, which may deliver a Congress more amenable to reality and less captive to ideology.