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Why Major Health Reform in 2009-10 Won't Solve Our Problems

Though the Obama health reform has become law and many think it revolutionizes our health care system, the reality is that it will do very little about our two biggest problems, costs and quality. Our costs are the highest in the world, and our quality is mediocre at best. We are getting coverage of three-fourths of our uninsured, but nothing in the bill will force physicians to follow protocols to move care more toward science and away from art, and the cuts promised in Medicare payments to hospitals and physicians are no more likely to occur in the future than they have been in the past. Not angering powerful interests meant not really cutting their earnings or telling them how to practice. New taxes and employer inducements to provide insurance or pay a fine were an inevitable product of lacking the political muscle to cut costs while having taken the bold step of reforming the insurance industry. That reform committed the president to an individual mandate to buy insurance, the only way of protecting insurance companies against adverse selection of sick patients once they give up refusal to cover pre-existing conditions. Our permeable political system, our health care history and ideological intransigencies make it hard to adopt truly comprehensive reform that controls costs and assures quality care.