A really nice, well-meaning group has sent me an embargoed e-mail about a seminar it will be having on how to make the U.S. health care system work better.
This group is a great, and I love it, and maybe the reforms it's talking about will work great.
Of course, private health insurers and benefits consulting firms have been vigorous about designing, promoting and helping to pay for those programs.
But, to some extent, I think the blizzard of releases about all of those great programs — and many Democrats' refusal even to consider changes in Medicare eligibility, reimbursement and plan design rules, and some Republicans' caterwauling about "death panels," and some of those same Republicans' war on annual and lifetime health insurance benefits limits — feeds Americans' current fantasyland economic philosophy.
The New York Times public editor ran a column this weekend about whether news reporters should talk about their politics, partisan views, etc., and, if so, how.
To me, one reason for reporters to avoid disclosing partisan positions is that it just seems really rude for a reporter to be intentionally, openly partisan, and another reason is that it takes the fun readers have when they're trying to figure out where reporters actually stand on issues.
Another reason is that, let's face it, who cares what reporters think about an issue. What do I know about health policy? I have views on health policy because I have a deadline, and my bosses want me to have a view on health policy. I'm not Karen Ignagni, Janet Trautwein or Karen Davis. The main purpose of me having any views about health policy at all is that I have some idea of what topics to write about and what questions to ask. I have to start somewhere. For you, the purpose of me expressing opinions is that you get to either go, "Yeah! Rah! You go, girl!," or, in your head (or using our comment form) rip me to shreds and perfect the way you're thinking about your own ideas.
But it does seem as if one idea I obviously have, and can't be coy about, is that, eventually, no matter how well we try to make health care more efficient, and succeed, and, no matter how well the economy starts growing again, eventually we're coming to crash into the problem that we want more care acute and long-term out of the universe than we can pay for, that we can reasonably pay a private health insurance company to pay for, and that other taxpayers really want to pay for.
On the one hand, it's fine to pretend that we'll all pay an infinite sum in taxes to make sure that other people will get the best possible care, but it's not true.
And, even just to get folks to pay somewhat more in taxes to ensure other people get a little bit of bad care: Where are the high-level officials talking about the possibility that we might run out of rich people to soak and might have to reach into our own raggedy middle-income pockets to chip in to that effort, if we have any actual interest in that effort?
On the other hand, pretending we have money that we won't have and that we'll have the energy to do things that we won't do is not very nice.
At some Grinch-like level, I wish we were talking somewhat less about the happy side of cutting costs painlessly while improving quality and talking somewhat more about the likelihood that we're going to have to keep some people who are great from getting high-quality care that would improve their quality of life and might increase their lifespans.
Floating along in the lala land where health system change always improves the quality of care and cuts the cost is nice, but maybe thinking more about the grim world of distributing pain would be better at prodding us to find ways to cut costs, scrape up more revenue, and admit to ourselves and one another that sometimes we have to make tough choices about where the money goes.
On the third hand: Maybe we could just get some dice and let them decide our fate. At least the dice would make up their minds based on gravity, momentum and random chance, rather than based on wishful thinking.
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