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Better health-care law is possible with compromise

Published January 29, 2011 1:01 am
This is an archived article that was published on sltrib.com in 2011, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

The passage of the Patient Protection and Affordable Care Act in 2010 represented a monumental legislative accomplishment. Health-care reform was no longer a far-off dream (or nightmare), but a near-reality.

Unfortunately, the passion involved in the process clouded the objectivity necessary to devise a long-lasting solution. As the debate continues, those involved in the decision-making process should be wise enough to avoid making the same mistake a second time.

Democrats and Republicans have both taken partisan approaches to the issue of health-care reform. Democrats hold firm to the legislation as it is, having already sacrificed much within their own party to obtain the requisite votes. Republicans have never been on board, as evidenced by the final voting tally and the current push for repeal, not to mention ongoing legal cases challenging the constitutionality of the "individual mandate."

The bickering, which seemed at its climax a year ago, is rapidly becoming the key issue of the 2012 elections.

In reality, neither side has it right. The Republican argument for total repeal would fail to solve the health-care crisis, and would place the country in a bind as it relates to aspects of the legislation which have already been enacted.

Accordingly, stripping the legislation of vital components instead of total repeal would make things even worse than they already are. The United States government would be on the hook for health insurance without the necessary financial tools to provide it.

On the other side of the aisle, the Democratic approach is also fraught with dangerous consequences. Lost in the noontime debates and midnight meetings is the fact that the basic logic of the legislation is faulty. In particular, the financial penalties associated with the individual mandate are not sufficient to guarantee that healthy individuals will purchase insurance. And if the individual mandate fails, the legislation fails as well. Neither the Democrats nor the Republicans have all the right answers.

This much is certain: Our current course as it relates to medical insurance is simply unsustainable. That being said, the new law is not the right solution — and neither is repeal.

Very few people argue with the premise that the health-care system is broken. Rather, the debate is centered on how to fix it and who should do the fixing. While Republicans and Democrats view the issue very differently, the ground for a true bipartisan solution is actually quite fertile. However, such a solution would require that legislators and policy makers set aside passion and embrace the objectivity necessary to solve a truly complex problem.

The objective context within which the health-care debacle lies is one in which a true solution will address not merely how insurance coverage is offered but how related services are provided. In The Innovator's Prescription, Clayton Christensen and his associates show that a realistic solution requires a change in how medical services are provided.

It is not the lack of risk-spreading alone that causes high prices, but the inefficient and anachronistic business models used by most health-care providers, which arbitrarily share overhead costs in an irrational attempt to be "one-size-fits-all" organizations. Other issues drive up costs as well, such as yet-to-be-addressed problems of medical education, clinical research and flawed regulation.

These issues, which will remain long after health insurance is universally available, are not properly addressed by either the reform law or attempts at repeal.

A solution to the health-care crisis is necessary — and it is possible.

But first, our federal legislators must forsake partisan passion in favor of productive objectivity. Utah's representatives can set the example by discussing the necessary components of a legitimate solution rather than holding fast to flawed alternatives.

Kurt Manwaring is pursuing a graduate degree in public administration at the University of Utah. He is currently researching the impact of health-care reform on substance abuse policies.






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