The Black Box of Health Care Reform

Disclaimer: I don't monitor the polls, listen to what pundits have to say, or keep up with political intrigues. These are my thoughts on the politics of health care reform based on my own anecdotal observations of everyday Americans.

The vast majority of Americans are happy with their health care. They may tell pollsters that they're unhappy (because it's fashionable), but actions are louder than words, and when it comes time for their Congressmen to make their health care very different from what it is now, their true preferences will be revealed.

So far, health care reform has been sold to the American public as a "black box". What's inside the box hasn't been clearly revealed. Americans have been told that there are some obvious shortcomings to their healthcare system and that there are easy reforms that can fix things. The nature of those reforms hasn't been important so far; it's just a pleasant idea.

Obama speaks of preventative care as if it's a magic solution, whereas in reality, there's little proof it will save money, and there's a good chance it will increase health care costs. Americans have been sold on the idea that the black box contains feel-good easy fixes like "preventative care". To the extent they believe health care reform will be as easy as more checkups, getting the right vaccines, and having more screening tests, Americans favor health care reform.

The reality is that any further involvement of government in health care will necessarily include some tough measures: rationing, capitation, less autonomy for doctors, some form of mandatory treatments, and no tort reform. To save money, you actually have to... spend less money. Sure, better diet and more exercise might be just as effective yet cheaper than coronary angioplasty for heart disease, but by golly, patients want to have that choice. When the same Americans who today tell pollsters that they want healthcare reform learn that they may not be able to undergo angioplasty, they will shout from the highest rooftops to prevent reform from happening. Americans are a stubborn people. They don't like being handcuffed.

Based on the people I talk to every day including patients, the tide is turning. The warm-and-fuzzy glow has worn off and we're now at the "hold on just a minute, let's think this through" stage. And the fight against health care reform has barely begun. The black box hasn't even been opened yet. If you were to ask the average Joe what's in the various proposals under consideration, he would have no answer. The more reform gets delayed, the worse it gets for Obamacare's chances. When the black box is fully opened, Obama better pray that the Democratic majority is enough to override the public sentiment.

If the black box is fully opened--if the public fully understands what reform actually entails--Americans will revolt against it just like they did under Bill Clinton, FDR, and Teddy Roosevelt. Reform might still happen given the Democrats' powerful position, but it will be unpopular and a watered-down version what was dreamed of at the time of the inauguration.

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People now care what is in

People now care what is in the bills being passed? Im not sure where you get that notion. Even the people signing them dont.

Would private health care really be eliminated?

In the UK we have the NHS (National Health Service) which is paid for by taxes and provides free(ish) heathcare. Treatment which is deemed not to be cost effective (i.e. too expensive) is not available on the NHS. But if you want the treatment and you have the money then you can `go private'.

I'd have thought that Obama is suggesting a system similar to ours rather than nationalising the entire health care industry as you suggest. Am I wrong?