Jennifer Foster: Balance is key to prescription for health care reform

President Obama and congressional leaders took the first real steps this week toward converting 20 years of campaign promises on health care into public policy.

Maybe you’re convinced that anything that comes out of Congress will be a disaster, considering the government’s established track record of sub-par customer service and rampant inefficiency. Maybe you think that the Uncle Sam’s involvement is long past due, and anything Washington can produce on this has to be better than the current system that divides patients into haves and have-nots.

Maybe, like most Americans, you’re somewhere in between.

Rarely do principle and practicality clash the way they will in this debate. For example, the Constitution makes no explicit provision for national health insurance. But having some basic assurances about their health care would sure help promote the general welfare of the 50 million Americans who are uninsured.

Among the host of complicated puzzles lawmakers must solve on road to reform:

* Quality. Americans owe the excellence they enjoy in medical care to competition. Health care providers willingly take on long years of preparation and significant personal debt for the chance to succeed based on their skill. The best doctors can name their price, and their income is the return they earn on their personal investment.

There is concern, then, that a government-sponsored health insurance program could have a deleterious effect on that quality of care. The cost-setting that would bring predictability and affordability to the market would also disrupt the principle of competition that drives it. Can lawmakers find a way to protect, and even encourage, competition within universality?

* Cost. Lawmakers are just beginning to talk about what the program could entail; they’re a long way from knowing how much it could cost or how they might finance it. But they are floating potential revenue sources (read new taxes). Some of the ideas include the possible elimination of certain itemized tax deductions – like mortgage and charitable contributions – and a new tax on employer-sponsored health benefits. Could the cure end up being costlier than the disease?

* Coverage. Once the government program is set up, non-participation – either in it, or a private program – may be enforceable by tax penalties or fines. Such a mandate may be the greatest hurdle to reform.

Obama said on the campaign trail that he believed uninsured Americans lacked coverage not because they didn’t want it, but because they can’t afford it.
Why bother, then, with an admittedly unnecessary mandate?

We risk losing personal responsibility in this debate. If the federal government is going to be in the business of insuring Americans’ health care, its bureaucrats are going to have their hands full enough without punishing those who choose to make their own way – or live with none at all.

The president insists that he doesn’t want to dictate Americans’ health care choices. Considering the recent, robust expansion of Washington’s reach into the private sector, isn’t it better for that argument if he doesn’t mandate their participation at all?

Rarely are congressmen and women faced with public policy decisions that have as much practical impact on the everyday lives of their constituents as the decisions they face on health care reform. It is the classic risk-reward scenario, magnified: The issues are complicated, and failure-inducing pitfalls abound.

But the payoff, if lawmakers can strike the right balance among these elements, has the potential to be great.

Jennifer Foster lives in Auburn and writes a column for the Opelika-Auburn News. She can be reached at