Although President Obama has learned from the health care debacle of the Clinton years by tasking the House and Senate committees with drafting a health care overhaul (placating the egotists in the world’s most deliberative body), the fact is that in order to win enough GOP and moderate votes, the plan will unfortunately not be as strong as it should be due to the numerous competing interests—doctors, insurers, neo-socialists, laissez faire-ists, unions, small businesses, etc.

            That having been said, the number of questions that Congress has to answer is staggering.  First, how far should health care be stretched?  Forty-six million people are uninsured, and millions more are doubtless underinsured (such as being denied coverage for preexisting conditions).  To close the gap would require $1.6 over the next ten years—not a huge sum considering that we spend $2.5 trillion annually on health care.  But given the bailout fatigue of Congress and the American public, ensuring that the plan hovers around $1 trillion is a key way to win the votes of moderate lawmakers.

            Second, how should the system be structured?  Should we mandate private coverage for every citizen and have the federal government subsidize those who cannot afford it?  Can a government-run system be created that will still allow insurers to compete?  Or can non-profit insurance cooperatives be formed in areas where there is not sufficient competition between insurers, wherein the policyholders own the corporation?  And what about the dreaded single-payer option—should we legislate insurance companies out of existence?

            Lastly, how will we pay for it?  The least aggressive option would be to tax sugary drinks, alcohol, and limit charitable deductions for the rich.  Another option would be to tax employees’ health care benefits above a certain level (in the $15,000-$20,000 range).  Or a national sales tax (Value-Added Tax) on all goods and services could be implemented—if the tax were high enough, millions of new families could even be exempted from paying income taxes.

            Naturally, Republicans do not want the government to run any aspect of health care, since they think a government-run system will be inefficient, incompetent, ration care, and augment the size of the federal bureaucracy.  Yet, they also seem to think that a single-payer system will edge out private insurers by somehow being more competitive.  It’s a seeming contradiction, but a demagogical sticking point.

            Part of the problem is envisioning what kind of monster will be in existence fifteen years down the road.  Obviously the government is able to run some programs well—it would be impossible to privatize our military, even though the Bush administration used an astronomical number of private security contractors in Iraq.  Other programs, like the Department of Motor Vehicles (which is run by the states) are demonized for being slow and inefficient.

            But then there are creations like Amtrak, which separated the social goal of providing passenger train service throughout the country from the economic goal of eliminating the burden of freight railroads having to operate money-losing, noncompetitive passenger trains by shifting operations to the government.  And the Postal Service is a government corporation which has competition from the private sector in the form of FedEx and UPS.  And then there are just plain old subsidies—like the kind the government gives to the airlines, without the government actually having to operate one.

            But the issue of funding a new system is even more problematic because someone must disproportionately bear the burden of new expenditures.  Taxing the benefits of workers would be unfair to unions, which have fought for greater benefits at the expense of higher wages—and not to mention it would break the spirit of President Obama’s promise to avoid raising taxes on the middle class.  It would also be unfair to northern states, whose citizens have a higher percentage of health coverage.  A national sales tax would impact poor people the most, while a limitation on charitable deductions would affect the wealthy.

            In short, for every American to agree to a revamped healthcare system, the government must prove that reform is superior to the status quo.  If everyone is to share the burden, everyone must benefit—either from improved care, increased productivity, or near-term reduction of the debt.

            Check back tomorrow for more comprehensive thoughts about health care.