Unlike many conservative pundits and commentators, I seem to have been absent the day they passed out Obama’s magic mind-meld helmet, so I don’t really know for certain what actions he’s going to take and what the focus of the new administration will be. What I do know is that on the campaign trail a lot of words have been spent discussing how to address our nation’s ailing health care system, and how to approach the goal of universal coverage. Obama, McCain, and Clinton all had their own ideas. And while some face time was given to Medicare, to my mind it was not nearly enough.
Medicare is our red-headed step child. Much effort and political capital was spent by the Bush administration pushing to “fix” Social Security. Compared to the estimated liabilities of Medicare though, Social Security’s future looks rosy. I understand some Democrats’ reluctance to confront the flaws in one of the pillars of our social safety net, but the need is most definitely there. Not only for the sake of the program, but for the larger impact on our health care system as a whole. In the discussion of the best road towards universal health coverage, the phrase “single-payer” has become anathema to many. And why not, when our limited experiment with single payer (Medicare) has such problems? Why should we vote ourselves into a program that appears to have issues just dealing with its current subscribers? This is why Medicare is so central to the debate on health care, especially for Democrats. Any movement towards an increased governmental role in health care will be regarded with skepticism so long as the problems in Medicare go unaddressed. And as for where to start, may I recommend to President-Elect Obama’s staff that they discuss with Senator McCain some of the proposals he suggested on the stump – cutting fraud, increasing adoption of technologies (like EMR systems), innovative care solutions (like PACE), and reforming payment methodologies (some progress was just made on this).
I personally believe that true universal coverage will only be achieved with a radical redesign of our health care system, and the likely adoption of a single payer system, though not necessarily on the Medicare model. Some of the ideas of Ezekiel Emanuel (Rahm Emanuel’s brother) and Victor Fuchs as presented in this TNR article and their book Healthcare, Guaranteed look very promising. But until the government can demonstrate that it can efficiently and effectively operate Medicare, the move towards such a system would be a true leap of faith.
