Academic

I have been thinking about Christine's assertion in her insightful post on Obama's unsatisfactory pitch for health care reform: "Hey, no one likes the health care system. We all want a better system."

While I suppose it's true that we all want a better system, I am starting to recoil at the notion that we should all dislike the health care system. During the past few months, our family has had myriad health care events, including routine checkups, radiology, physical therapy, surgery, and hospice care. We have always received timely treatment, and we have been satisfied with the quality of that treatment. As you would expect, our satisfaction varies with the treatment provider -- some are excellent and others not so much -- but I would say the same about service in restaurants, car dealerships, and grocery stores.

Maybe our treatment costs too much. I am told that the U.S. system is expensive, but I don't feel personally burdened by health costs. Yes, a good chunk of my paycheck goes towards my insurance, but we consume a great deal of medical care, so that seems like rough justice to me. Another chunk goes toward government health insurance that currently benefits people outside of my family (Medicare, Medicaid), and I am ok with that, too.

My general sense of satisfaction with the health care system doesn't seem to depend on where I live. We have lived in umpteen states from Delaware to Oregon and from Wisconsin to Louisiana and had roughly the same experiences everywhere. Sure, I would love to get uniformly better treatment at a lower cost, but none of the current reform proposals are headed in that direction. The last time I heard anything about improving the quality of my medical care was weeks ago, and the big selling point on costs has been that the federal government will not increase the amount I pay for health care. (Now, you can even scratch that selling point.)

If you are still reading, you are probably thinking something along these lines: "Of course you are happy with your health care. You make enough money that you can live in a nice community and pay for good insurance."

You would be right to say all of that, but that is precisely the point. People in the middle class tend to be more or less satisfied with their own health care. We aren't much interested in the claim that health care reform "may start us down a treacherous path toward government-encouraged euthanasia." And this is not about federally funded abortion, at least not yet, or about big, scary government limiting our freedom to be fat and addicted to tobacco. It's about the fact that Congress and the President want to add 45 million people to the ranks of the insured -- most of whom are employed and young, for what it's worth -- without impairing our access (where are the extra doctors coming from?) and without increasing our costs. Oh, right, ignore that bit about the costs.

In short, the problem with health care reform is that reformers have not made a case that health care reform will do anything other than make my life worse. Apparently, the Democrats agree with my diagnosis:

With Republicans making headway by casting the legislation as a costly government takeover, Democrats have decided they must answer the question on the minds of those now insured: ?What?s in it for me??

Will they succeed in convincing us of the need for reform? I think they have a good chance of convincing us that the regulation of health insurance companies needs to be tweaked. Beyond that, this is a tough sell. Then the issue will become whether the Democrats want to push something more ambitious through over the objection of Republicans (and Blue Dogs?). It's hard to imagine a more thrilling prospect for Republicans who want to regain control of Congress.