Health-Care Reform Needs Holistic Approach

But even Obama could not resist the temptation to demonize those he says he wants to invite to the table, referring to "profiteering" by the drug and insurance companies and the "stranglehold" they have over the marketplace.

This kind of overheated rhetoric is not only unfair and unproductive but also out of date. It ignores the reality on health reform -- that just about every important interest group acknowledges that today's health-care model is politically and financially unsustainable, that universal coverage is inevitable, and that everyone is going to have to accept major changes in how they do business and how things are priced and paid for.

Doctors and hospitals know that, in the future, they will be have to give up some of their autonomy and treat their patients according to proven best practices ("evidence-based medicine" and "disease management"), with their compensation based on how well they adhere to these protocols ("pay for performance").

Insurers realize that their profits will depend on how successful they are in managing care rather than how clever they are in cherry-picking the healthiest customers.

Drug companies realize that they will have to accept some limits on their marketing and will no longer be able to overcharge Americans while undercharging consumers in industrial and middle-income countries.

Politicians understand that tax money will be needed to subsidize premiums for the poor and near poor.

Unions understand that the days of first dollar coverage are gone and higher deductibles and co-payments will be required for all but preventive care.

The small-business lobby understands that universal coverage is coming and that its members will be required to help finance and administer it.

And everyone accepts that they will have to invest in new information technology to reduce administrative costs and medical errors and make it possible to evaluate the performance of individual doctors and hospitals.

Obviously there are lots of highly contentious details to ironed out. But that process will be made even more difficult if the politicians who ought to be encouraging it are scoring political points by setting up a phony battle between white hats and black hats.

We are all implicated in the failures of the current system -- consumers and providers alike. And what everyone should have learned from the last time is that nothing can happen unless the major interests are convinced they will be better off with reform than without it.