By Evan Falchuk
Warren Buffet is talking and reform opponents love what the unofficial Obama adviser has to say. He says the President should scrap the whole thing and start over.
He says health care costs are a “tape worm” eating at American competitiveness. His prescription: a “united effort,” a “national emergency” that will allow us, finally, to focus on “costs costs costs” above all else.
Buffet is a brilliant man, and he makes a very good point about how botched the sales job on reform has been. But he’s missing something very important:
We have been focused on health care costs in America. For decades.
It’s true.
The entire system of managed care, under which we all live, was created for the purpose of controlling costs. The number one priority for employers (well, at least private ones) is controlling costs. And yet costs have continued to rise. It’s not because people aren’t trying – there are lots and lots of different ways in which organizations have tried to control costs – some of which work well. The trouble has been that by looking at everything in medicine through the prism of money we are distorting the way medicine is supposed to work. Instead of it being about how to make sure a doctor and a patient are able to work together to get the best possible outcome, it’s about making sure the doctor and the patient don’t spend too much money. It’s a mistake, and it seems to only make things worse.
But there is a larger problem with reform. American health care isn’t really a “system,” and so trying to reform “it” is pretty impossible to do. It’s like saying we need to reform the automobile “system” in America. Are you talking about roads, or mileage standards, or unions, or executive pay, or manufacturers, or parts suppliers, or foreign companies, or state governments, or the financing companies, or dealers, or what, exactly? Maybe individual players in this market could – and do – focus on “costs costs costs,” but as a market there’s no coherent way really to do that.
The trouble begins when you start to look at health care as a system and try to come up with ways to reform it. It’s why there has been such a yearning for simple, easy to understand rhetoric to explain reform to a skeptical public. No one has found anything that works, and so reformers find themselves in a political quagmire.
A great sage once said that one of history’s classic blunders is to get involved in a land war in Asia. Perhaps to that ought to be added, never try to comprehensively reform American health care.
UPDATE: CNN reports (h/t James Taranto) that a White House adviser yesterday called the latest health care push “the last helicopter out of Saigon.” Not good.
