Is True Health-Care Reform Doomed?

The Obama administration's push on health care has resulted in a 1,017-page House bill and squabbling senators.
The Obama administration's push on health care has resulted in a 1,017-page House bill and squabbling senators. (By Alex Wong Via Bloomberg News)
By Allan Sloan
Thursday, August 27, 2009

One of the good things about spending vacation time away from the computer and second-by-second news is that it's easier to see the big picture. And one thing that came into focus during my recent beach time -- and is even more clear today -- is that the health-care "reform" making its way through Congress has disaster written all over it unless there's a clear, understandable and affordable public option in the final version.

Even with a public option, it may be a disaster unless it's carefully thought out. Alas, care and thought don't seem to have much sway these days with all the shrieking about "death panels" and getting "the rich" to pick up the tab for everyone.

My problem has nothing to do with the supposed socialization of medicine and the various other horrors invoked by opponents. My problem is that any piece of legislation that runs more than 1,000 pages -- the House version weighs in at 1,017 -- is certain to contain enough ambiguities, contradictions and just plain mistakes to ensure years of lucrative employment for countless lawyers, lobbyists and experts who will pick away at it.

I'm profoundly unimpressed by people who wave around pieces of the legislation to "prove" this or that. That's because something as long and complex as this has plenty of provisions that allow you to show whatever you want to show. A Rorschach test, as it were. It's like citing verses from the Bible or the Koran to "prove" philosophies ranging from universal love to a sacred duty to destroy unbelievers in the name of God.

I'm no fan of our existing health-care system, even though it's been working fine for me because I'm well insured, have access to family and friends who are doctors, can afford out-of-network specialists, and have generally managed to end-run the hideous insurance company bureaucracies that drive more and more medical decisions.

With all due respect, the idea that there is a "free market" for health-care consumers is nonsense. A free market assumes that participants are knowledgeable and understand the choices they're being asked to make. That's not the case with health care, as anyone who has tried to analyze Medicare-supplement plans or pick among insurance options offered by his employer can tell you. Should you find yourself in a rural area far from home with a mysterious and troubling pain, you're not exactly in a position to bargain with the local walk-in clinic or hospital emergency room.

The health-care status quo isn't going to work over the long term. For one thing, absent a huge change, the cost of Medicare threatens to financially cripple the country. Plus, we already have non-medical forces determining how care works. Insurance companies increasingly try to tell doctors and hospitals and medical-device makers what procedures to perform, what to charge for them and what drugs to prescribe.

Talk to any doctor in a practice that's part of an insurance network, and you'll probably find there's at least one form-filler-outer for each physician. Medicare, which covers about 45 million people, isn't any fun for doctors -- some of the reimbursement levels are ludicrously low -- but at least they know when they'll get paid and what's covered and what isn't. Insurance companies are far less consistent in what they cover and what and when they pay.

For the most part, the only ones who actually pay -- or try to pay -- the full stated price of hospitalization and prescription drugs are uninsured or underinsured people, who frequently go broke trying to cover their bills. People with good medical insurance and prescription-drug plans benefit from the steep discounts that insurers negotiate.

Had the Obama administration tried simply to expand Medicare, with all its imperfections, I'd be a lot more confident about health-care reform achieving something useful. If there were a simple, clear public option providing benchmarks against which to measure insurance company performance, that might work. But no public option and a 1,017-page bill designed to fix our medical system? Good luck on that, fans. Even at the beach, there will be no escape.

Allan Sloan is Fortune magazine's senior editor at large. His e-mail address is

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