Changes Coming For U.s. Healthcare: Understanding The Various Proposals

By Author: Jerry Wetzstien
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For some people, the healthcare debates in both Congress and among the citizenry pit "big money interests" against "the people," whereas others see the controversy as a clash of political and world views. The legislative wrangling continues while the press, less composed of neutral observers presently than in Walter Cronkite's day, tends to propagandize perhaps more than inform, at least in the sound bites and headlines, making it hard for Joe Public to get the basic facts upon which they can make a decision. What changes are coming for U.S. healthcare, and how does one attain at least a basic understanding of the various proposals? Let's try to break that down.

The first thing to remember is that some points brought up in this article may be old news the day after it's posted or published. You need to stay abreast of the news yourself, and the best advice for getting at least within striking distance of accuracy, no to say "truth," is to read a range of opinion, including sources from outside the U.S. media. Some people are far too busy trying to stay afloat in the rough seas of economic uncertainty to do much of this, ...
... and therefore the recommendation for them is to remain skeptical of anyone claiming to have "the answer."

A little background

Truth be told, the health care problems we face today began during World War II. At the height of the war, wage and price controls were in force throughout the American economy. The only way that businesses could compete for workers was to offer health care benefits, and the FDR administration made a deal with business to allow these benefits to be offered. From one side of today's debate comes the quite uncontroversial notion that this action may have removed people too far from the process and insulated them from thinking about costs and usage. With a third-party payer, whether an insurance company or the government, people have no incentive to reduce usage or costs.

From the other side of the argument comes a rejoinder, that people have a "right" to health care. This is a new use of the term "right," in the American sense, at any rate, since our Constitution and Bill of Rights are built around "negative rights" and "enumerated powers." That is, we have rights to speech, assembly, press and habeas corpus (a court system) that the government cannot eliminate, and the government has a defined set of powers that are "enumerated," or listed. People can disagree on whether this should now be the case, or what systems should be in place today, but it is clear from reading history that our system began with these common perceptions.

And now?

Health care providers, doctors, hospitals, pharmaceutical manufacturers, insurance companies, HMOs, government programs-everything and everyone in the health care industry, and the 300 million American consumers of health services, is in a state of flux. There is no clear path to reform, the debate seems to be getting more vitriolic and politicized all the time, the clash continues and the problems persist. Where is the solution? Is it on the left, the right, in the middle, nowhere on the political spectrum or in its own little universe?

As with most American controversies, the "political class"-newspaper columnists, elected officials, lobbyists, the broadcast media, reporters and so on-is fractured into various alignments and interests groups, just as much as the "health care businesses" are. The citizenry, whether well-informed or not, is solidifying into thick-skinned groupings defined by politics, class, tax brackets and regional interests. It may be time to try stripping away the politics and bringing the argument back to individuals, rather than "group ID."

If the idea is to help those who are uninsured, perhaps people who are satisfied with their coverage should be left alone to buy what they want. Supporters of universal health care claim that everyone must join for it to work, but that depends heavily on their definition of what "works," which can be brazenly self-serving. As with other American welfare and "safety net" programs, it should not be impossible to help the most needy while leaving those in better situations to make their own decisions.

How to proceed

As the reform movement pushes forward, perhaps we can all frame the question a bit more broadly, and not try to convince each other of any one-size-fits-all solution. America's heritage is one of freedom, not coercion, and the notion that we are obligated to one another, beyond family and friends and irrespective of our own wishes, is still alien to many.

The solution that helps the neediest, and leaves others to make their own choices, would seem to be the most balanced. It remains to be seen whether the individualist or the collectivist mentality becomes the reigning model. Keep reading, keep thinking, stay open-minded and dig past the propaganda, from all sides, to where the facts are. And stay tuned!
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