When I asked Stanford health-care economist Victor Fuchs back in 2005 what it would take to significantly reform the U.S. health-care system, he said nothing short of a monumental national disaster would do the trick. A shock to the system on the scale of World War II, he suggested. So ever since, I've been asking myself: Are we there yet?
I've been hoping that the black clouds of the financial crisis will reveal silver linings of health-care reform. But according to the former editor of the New England Journal of Medicine, Arnold Relman, it's not likely. He assesses the forces at work in the July 2 issue of the New York Review of Books in a review of Healthcare, Guaranteed, by Ezekiel Emanuel (older brother of Obama's chief of staff) and with a forward by Fuchs. He also shares his impression of the Obama administration's fix. It's depressing.
Commenting on a health-care reform plan he says resembles the Obama administration's -- a white paper produced by Montana Democrat Max Baucus, chairman of the influential Senate Finance Committee -- he says:
There is little evidence in this document of a strong determination to challenge the private insurance plans with a competing public plan, or to make basic changes in the organization and funding of medical practice. Timid legislative tinkering with the current medical care system and a focus on increasing coverage, rather than major reform, are not going to control costs or make much difference in the quality of care.
The article ends with a prediction of continuing heavy cloud cover for the present -- and a glimmer of hope for the future.
As bad as they already are, things will have to get still worse before major reform becomes politically possible. The legislation likely to emerge from this Congress will not control -- and will probably even exacerbate -- the inflation of costs. But sometime in the not-too- distant future, health expenditures will become intolerable and fundamental change will at last be accepted as the only way to avoid disaster. When that time arrives, the opportunity to enact real health reform will finally be at hand.
If anyone would poke some holes in this gloomy forecast, I'd be much obliged.
Photo by Jaroslaw Pocztarski