After health reform passes

There has always been a Perils of Pauline quality to the health care debate. (Picture from Wikipedia.)

There still is.

But I’ve seen movies like this before, and it is increasingly likely that the Senate bill (as amended) will pass.

Credit Republicans. Their hope was always to disgust moderate Democrats, and they nearly succeeded.

But they overplayed their hand. Not just with over-the-top rhetoric, but by making it clear that even the most conservative Democrat would be targeted, pursued, and run to ground after this debate, no matter its outcome.

Once this became a party line issue, a loyalty test, Democrats came to the aid of the party and the whipping got easier. Even Dennis Kucinich came around.

Republicans, being the minority, need the issue in November more than they need to win on the floor. They seem satisfied to have it.

There will be some preening and posturing over the next few days, but the way now seems clear. No Congresscritter wants their party’s President to fail. It’s how Bush got his tax cuts, and how Reagan got his.

Democrats learned the lesson the hard way in 1994. They’re not stupid. (Commenters will get no argument from me or other Democrats if they claim Washington Democrats are indeed stupid.)

So what happens now?

Real health reform, the cost controls on which any program must be based, is already baked-in. The $19.2 billion in HITECH funds, delivered last year through the stimulus, will in time give patients access both to their own data and to people who know their true condition. Nurses, physicians’ assistants, even health coaches.

There have always been incentives for insurers to reduce the costs of care, from their business customers. But now comparative effectiveness studies will become widely disseminated, telling doctors what they should be doing, and telling insurers what they should not be paying for.

It’s this flood of data that is the real health reform. The legislation is just about who pays, and how. How much they pay is a market process, but that process has been hampered by the lack of a thumb on the buyer’s side of the scale.

That thumb will now be deployed.

• How many scans do you need? How many tests, how often?
• When must we remove a cancer, and when is it best left alone?
• When should compliance with medical advice become required, on pain of losing coverage?
• How do we make wellness cool?

These are the real questions. How can we keep you well, and what is your responsibility in that regard? How do we make practices uniform across the industry, so everyone gets Mayo treatment at a Mayo price? What is the government’s role, not in deciding who pays for care, but how much care will be given?

These are the kinds of debates people have in other countries all the time, not just “socialist” countries but every country. Poor countries as well as rich ones.

Not who pays, but how much will be paid from a common pool? What are the limits of that pool, the point at which only the market (in the form of your own money) can offer hope?

What Republicans have most feared throughout this debate is the end of “American exceptionalism,” the idea that America is different (therefore better) because it adheres most strictly to the dictates of the market, and the jungle.

That’s what this debate has been about. That debate is ending. And America will, on questions of health, become more like other countries as a result. Not identical, surely. But more alike.

For those Republicans who have threatened to move if health reform passes, the bad news is there is no place to move to. Except maybe Somalia.