South Carolinian Civility

Joe Wilson's outburst the other night recalled another instance of Congressional incivility, when Preston Brooks, Representative of South Carolina, confronted Sen. Charles Sumner of Massachusetts on May 22, 1856, during the "Bleeding Kansas" crisis, and beat him nearly to death. Have health care and immigration reforms assumed the passionate intensity of the slavery debates? In both events, it was South Carolina, which boasts of a culture of gentility and chivalrous virtues.

Ooops! Cynthia Tucker beat me to it!

Bringing Sanity to the Health Care Wars

In my youth, my uncle Elliott, an insurance man, drummed into me that insurance was designed to protect against catastrophe, against those losses that our household asset base could not absorb without risking insolvency. (I recognize that businesses may use insurance for somewhat different purposes from time time. I'm focusing on non-business households.) I was always puzzled at the way the insurance industry had taken over healthcare, starting with servicing the billing and payment process. The whole system seemed to promote the attitude that we were entitled to have our healthcare bills paid by a third party, that there was something wrong with us if we had to pay medical bills out of our own pocket.

Consequently, I was recently struck by a recent column by David Brooks, Let’s Get Fundamental, and, as is frequently my wont, I decided to read a couple of the essays to which Brooks had referred. I have been getting progressively more frustrated by the so-called "health-care debate," which has been giving off huge amounts of heat but very little light. Brooks has been a steady voice in favor of reform of the system, and has focused on the perversity of the incentives in America's delivery of health care, which have driven the country to the brink of bankruptcy.

One of the essays Brooks commended appeared in September's The Atlantic and was authored by David Goldhill. In How American Health Care Killed My Father, Goldhill summarizes the situation in this way:

"A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing."

Of course, his prescription is not limited to increased access to the exisitng system. In his view, with which I agree, we need to wrest the system away from the insurance middleman, and retake responsibility for our health.

A report by the Brookings Institution, Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth, also cited by Brooks, reaches conclusions similar to Goldhill about how to move forward:

This strategy consists of four interrelated pillars. First, as a foundation for improving value, all stakeholders in the system need better information and tools to be more effective. Second, provider payments should be redirected toward rewarding improvements in quality and reductions in cost growth, providing support for health care delivery reforms that save money while emphasizing disease prevention and better coordination of care. Third, health insurance markets should be reformed and government subsidies restructured to create competition and improve incentives around value improvement rather than risk selection. This step requires near-universal participation in insurance markets to succeed. Finally, individual patients should be given greater support for improving their health and lowering overall health care costs, including incentives for achieving measurable health goals.

It will be interesting to see what the President's prescription is. Has he allowed the dysfunctional legislative train to get too far down the track? There's no question in my mind that he and his people understand the perverse incentives emmbedded in the current system. Does he have the courage to put on the brakes and stake out a new direction? We'll see.