Once again Washington politicians are attempting to bring us health care reform, but as has happened so often before, the debate will be truncated and no really tough choices will be made, in order to hold together a political coalition to get a law enacted.
For the politicians, passing a law is the goal. They don’t worry themselves with whether it can actually be implemented or achieve what they have promised. Most likely, they won’t even read it before voting on it.
More of Same
We’ve been there many times before. Grand promises are made, laws are enacted, and the politicians declare they have solved the problems, but no good ever comes of it.
In 1988, then-governor of Massachusetts Michael Dukakis declared when signing his health care reform law, “Massachusetts will [now] be the first state in the country to enact universal health insurance.” The next year, then-governor Barbara Roberts of Oregon declared, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.”
In 1992, then-governor of Tennessee Ned McWherter said, “Tennessee will [now] cover at least 95 percent of its citizens.” In 1992, then-governor Howard Dean of Vermont said, “This is an incredibly exciting moment that should make all Vermonters proud.” Similar declarations were made in Kentucky, Maine, Washington, and other states.
All of these laws have since been repealed. Not one of them worked as promised. In most cases they made no difference at all or even aggravated the problems they were supposed to fix.
Failed National Plans
The same thing happens at the national level. Faced with increasing demand for services and rising costs due to the then-new Medicare program, Congress enacted the National Health Planning Act in 1974. The idea was to reduce costs by limiting the supply of services—exactly the wrong strategy at a time of increasing demand. It failed and was repealed after years of bureaucratic boards, consultants, hearings, and regulations.
In 1988 Congress enacted the Medicare Catastrophic program, requiring people on Medicare to purchase coverage for prescription drugs and copayments. It was endorsed by AARP, passed by a Democratic Congress, and signed into law by Ronald Reagan. But beneficiaries didn’t understand it and didn’t like it. In Chicago, elderly people chased House Ways & Means Committee Chairman Dan Rostenkowski down the street and beat on his car with their canes as he tried to escape. The law was quickly repealed.
Actually repealing a law is very unusual in Washington, unlike the states. Usually there are enough people making money off a law, no matter how ineffective, that it stays on the books forever. That’s the case with a host of federal laws and regulations that may not cause riots in Chicago but don’t work very well and cost a fortune—COBRA, HIPAA, SCHIP, Medicaid, and so on.
More Failures Likely
And so it will be for the laws already passed this year, on health information technology and comparative effectiveness research. Lots of consultants and vendors will get rich at taxpayers’ expense, but very little good will be accomplished.
And that is the likely effect of President Barack Obama’s big health care reform law yet to be enacted. Bells will ring, flags will fly, and bands will play for the signing ceremony. Grand speeches will be made about how “we have given you health care.”
But in the end it will never be implemented, or it will solve nothing and may even make the problems worse than they were before. Promises, promises.