By Evan Falchuk

Why has health care reform run into so much trouble?

Well, it could be because people think reform plans will affect them in ways they aren’t going to like.  Or because people don’t believe politicians in Washington who say that spending huge amounts of money will actually save money.  Or because confusing mixed messages and ever-shifting sales pitches create a lot of anxiety about what’s really going on.  It could be all of those things.

Or, it could be something more….sinister….

At the Washington Post, Ezra Klein thinks he’s figured it out.  It’s a growing, 100-year old, conspiracy:

Over the past hundred or so years, the health-care system has gone from a very small portion of our economy to about a fifth of it. That’s a remarkable rise. And it has been accompanied by a similar rise in the political power of the health-care industry. I’ve previously argued that the history of health-care reform is a history of decreasing ambition: FDR and Harry Truman propose something like single-payer, John F. Kennedy and Lyndon Johnson ratchet back to single-payer for seniors and poor people, Richard Nixon and Bill Clinton offer national systems that rely on private providers, and now President Obama is building a private system that’s initially limited to small businesses and individuals.

There are a lot of reasons for that. One is that political defeat engenders future timidity. But another is that the gaps between proposals give the health-care industry time to grow even larger and more politically powerful, which means that the next president who takes up the issue is faced with a more daunting task and pulls back his ambitions accordingly.

It’s an interesting perspective on history.

President Johnson succeeded in getting the Medicare and Medicaid programs Klein suggests were part of this century-long losing streak.  Meanwhile, about 50 cents of every health care dollar in America is today spent by a local, state, or federal government.  Mostly anything that touches health care is heavily regulated at one level of government or another.

Does this sound like the kind of thing you would expect in a world in which a “health care industry” was increasingly calling the shots?  Would a “health care industry,” eager for money, really want there to be 30 million uninsured Americans, unable to spend billions of dollars on their goods and services?  Of course not.

So what’s going on?

For starters, health care was so much less expensive 100 years ago because it was primitive.  No anitibiotics.  No effective treatments for cancer, heart disease, diabetes, or any number of other serious, chronic diseases.  All the stuff that is increasingly available to help people get well costs money.  People, rightly, demand these advances.  We aren’t spending one-fifth of our GDP on this because we’re being snookered into it.

But more broadly, Klein falls into the same trap that so many others do in talking about the health care.  What is this “health care industry” that Klein thinks is calling the shots?

Does he mean health insurers, the federal government, hospitals, medical device manufacturers, pharmaceutical companies, biotech companies, doctors, nurses, assisted living facilities, the VA, medical schools, managed care companies, ambulatory care centers, state governments, church-owned hospitals, walk-in clinics, pharmacies, lawyers, self-funded employers, dialysis centers, alternative-medicine providers, home health care workers, patients, ambulance companies, reinsurers, local governments, rehabilitation centers, dietary supplement makers, charities, nurse practitioners, or…who exactly?

This tremendous collection of groups — and many others — make up the health care economy.  Very many of them are completely at odds with each other.

It’s illogical, and, in fact, untrue to suggest that these groups have somehow gotten together to do much of anything.  They certainly aren’t figuring out ways to stymie government efforts at reform.  Indeed, I would bet that most of us working in that economy know better than anyone that American health care is beset by problems that the government could do more to address.

And so it is easy, when faced with failure, to look for external forces to blame.  Reform proponents need to recognize that the failure to get support for their programs has everything to do with how they went about their business, not some mysterious outside influence.

It’s no conspiracy.