Socialized medicine. Government-run health care. Rationing. Bureaucrats in charge. "Cookbook" medicine. Waiting lines. It'll break the bank.

Welcome to the health care debate 2009. Sound familiar? These notions aim to instill fear. And once again, they bear no more relation to the reality of what is being debated in Washington than was the case when the Clintons had a go at health reform in the 1990s. Don't be misled this time. In fact, far more bipartisan agreement exists on many core elements of reform than you might think.

Socialized, government-run health care? Nothing President Obama or Congress is proposing would replicate the Canadian, British, or French systems or remotely resemble nationalized medical service. Rather, the proposals offer repairs to an American system that is both broken and going broke. Those proposals build on our current private system where most people younger than 65 get coverage through their employers and treatment through private-sector doctors and hospitals.

What would be new is that people who don't have access to such coverage (and some who do) would be able to get coverage through insurance "exchanges." They'd be able to choose from a batch of private plans and policies that would have to accept all comers, offer comprehensive coverage, and be barred from "cherry-picking" only healthy people.


Guess what? Democrats and Republicans embrace the idea of exchanges and broad new federal insurance rules. They also agree that this new proposed system would be a boon to private insurers, doctors, hospitals, nursing homes and drug companies. That's because tens of billions of dollars of government funds would help many of the 46 million uninsured get coverage.

Those subsidies are one big reason insurers are so opposed to the idea of a "public plan" being offered in the exchanges; they don't want to lose any of those new customers to a government-run plan.

Is single-payer the goal?

The debate over the public plan also puts the distorting rhetoric on full display. Opponents say the idea is the proverbial camel's nose under the tent toward a European-style "single-payer" system. But the reality is that it wouldn't be that difficult to design a public option that abides by the same rules as private insurers and has no competitive advantage.

Cookbook and rationed care? This fear stems from concerns that the government aims to dictate what doctors do and cut costs by limiting access to care. These notions are wrong. Rather, what Obama and both Democratic and Republican leaders want to do is aggressively measure the quality of care that doctors and hospitals deliver and change the way those providers get paid so quality of care -- rather than quantity -- is rewarded. That's hardly a socialistic notion. Insurers and large employers are already headed down this road anyway. Though your doctor might be terrific, studies over two decades show conclusively that on any given day in the U.S., about a third of what doctors collectively do is unnecessary, inappropriate or useless. That adds up to an estimated $400 billion to $600 billion a year in excess, wasteful spending.

Far from leading to rationing, shedding light on, and then correcting, bad care practices would lead to better, safer, more efficient care -- while saving money. It would just take time.

Can we afford reform? This is the real toughie. Proponents insist that not reforming the system is the real financial risk. On the current trajectory, medical costs will soar to 28% of the U.S. economy by 2030, from 18% today, and the average family will have to pay about $25,000 for insurance by 2025, from $12,000 today.

But these sobering statistics don't erase the immediate and acute problem for lawmakers: An upfront investment (for at least seven years, I expect) would be required to expand coverage and create new infrastructure, such as the exchanges and electronic health records systems, before significant savings could be realized.

Think turning a giant supertanker on a dime. On top of that, some economists, and the Congressional Budget Office, are skeptical that the changes being proposed would ever yield enough savings to fully cover the cost of insuring all Americans.

Leap or stay put

So do we take the leap? Polls show that Americans are deeply worried about this dilemma, especially given today's economy. Even so, the public also seems to understand that the leap must be taken.


I agree and would urge some creative thinking. The medical industry must be challenged to cuts costs; its bloated General Motors gas-guzzler mindset must be radically re-engineered (just as GM is being). Enforceable targets on reducing waste must be set. New, more efficient care systems must be invented. Government must use its buying clout more assertively as it pays for the care of millions of Americans enrolled in Medicare, Medicaid and other public programs.

Health industry representatives recently pledged to Obama that they would take on this job. And last week, the drug industry promised up to $80 billion over the next 10 years to help defray the cost of coverage expansions and directly help some seniors in Medicare pay for their medicines.

Could this be a sign that the inflamed passions and ideological posturing will at long last give way to getting the job done?

Let's hope so.

Steven Findlay is a senior health policy analyst at Consumers Union in Washington.