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An Unhealthy Debate
Rhetoric and distortion imperil the opportunity to fix the American health-care system.

Sunday, August 9, 2009

WHEN IT comes to health-care reform, August is shaping up as the loudest month. Angry protesters, spurred by conservative groups, shout down Democratic lawmakers at meetings to discuss reform, with congressional Republicans cheering these "recess roastings." Congressional Democrats lash out at what House Speaker Nancy Pelosi (D-Calif.) described as "villainous" health insurers making "immoral profits."

These are unfortunate, unnecessary and counterproductive developments. No one, liberal or conservative, Democrat or Republican, should be happy with the current system, which spends too much to cover too few. Insurance is increasingly unaffordable. Even those with coverage are at risk of losing it, being denied needed care or being locked into jobs because of preexisting conditions. Rising health-care costs threaten the economy, while entitlement spending consumes a growing proportion of the federal budget.

The moment is ripe for a responsible fix, which is what makes the current eruption of smackdown politics all the more depressing. Among serious lawmakers of both parties, there is more agreement than during the Clinton health-care battle of 1993-94 about the need for an overhaul. The hard-edged opposition of interest groups that helped kill the Clinton plan has softened; sensing the inevitability of change, insurers, pharmaceutical manufacturers and hospitals have been trying to position themselves to cut the best deal possible rather than to kill reform outright.

If this moment is squandered, it will be a sad indictment of the political system -- and there will be plenty of blame to go around.

Republican lawmakers and conservative activists have fanned the flames of uninformed opposition with familiar warnings about government-run health care and socialized medicine and irresponsible new twists, such as the suggestion that the proposals under discussion would strong-arm seniors into euthanasia.

Democrats, with polls showing increasing nervousness about health care, have resorted to vilifying the health-insurance industry. No doubt, insurers engage in rational but disturbing practices under the current system: They angle to attract the healthiest customers, refuse coverage to the riskiest and seek to avoid paying claims. But the insurance industry of 2009 is in a far different place than it was 16 years ago; it has agreed to accept all applicants and generally charge the same amount, in exchange for a requirement that all individuals obtain insurance.

So it is disappointing, to say the least, to see Ms. Pelosi and other Democrats revert to round-up-the-usual-suspects demagoguery. President Obama has been more restrained but hardly more accurate; in a news conference last month, he inaccurately complained about insurers making "record profits, right now." In fact, among U.S. industries generally and other parts of the health sector in particular, insurers are not particularly profitable. The latest Fortune 500 ranking of most profitable industries has pharmaceuticals third, medical products and equipment fourth, and health insurers down at No. 35. Drugmakers reported a 19.3 percent profit margin; insurers, 2.2 percent.

More fundamentally, the Obama administration is peddling health reform as an everybody-wins scenario in which no one, except perhaps the wealthiest of the wealthy, has to sacrifice anything. We recognize that selling dessert is easier than selling spinach, especially when the other side is falsely claiming that your food is poisonous. But if health reform passes and starts bringing down costs, it is going to pinch some patients who have become accustomed to getting every test or procedure they want. At that point, Mr. Obama might wish he had done a little more to prepare people for the changes.

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