For Teddy. . . .

For the last several weeks I’ve been busy not-writing about health care. This explains the relative paucity of my blog entries recently. It’s been painful enough just watching the death spiral of health care reform, and writing about it is harder than trying to ignore it. But writing about anything else is actively not-writing about health care, so, sooner or later, I have to try to come to terms with my feelings about this and put something down in writing and up on the blog.

Welcome to later.

Columnist Michael Gerson today has a somewhat charitable view of why things haven’t gone better, presenting some more-or-less rational reasons why most people have never been on board with reform efforts. In part, the problem lies with the majority of Americans who do have health insurance and are risk-averse to changes which might reduce their coverage. In part, it lies in the general mistrust of big government and its ability to deliver on big programs to solve social problems. And in part, it lies in the almost universal concerns that we’re running massive deficits and are still in the middle of the worst recession since the great depression.

(The projected deficit was just revised upwards yesterday from $7 trillion to $9 trillion. I have no idea how much money a trillion dollars is, but I know it’s enough to buy billions of Happy Meals and have enough left over to buy a few million minivans, so from that perspective you could see how the average family would be concerned.)

And part of the pain­ that makes it hard to write about this is in watching the rapid decline in the public’s confidence in Obama and the inevitable decline in popularity as confidence goes down. I’m not even sure the average American still thinks his kids are cute anymore.

But despite all the rational reasons Americans might be concerned about health care reform, the biggest obstacle still has to be Republican determination to crush Obama. "If we're able to stop Obama on this, it will be his Waterloo. It will break him," said South Carolina Republican Jim DeMint. And let’s not underestimate the power of The Big Lie, no matter how stupid. The best argument I can imagine for Death Panels is Sarah Palin herself. We could send her down here to Oregon for a nice cup of assisted suicide.

It seems now that all is lost, that once again we’re going to say, “No healthcare for you!” 45 million times. But if we really can’t find a way to extend coverage to these unfortunates, I suggest we at least spread the pain around a little more fairly. We could have an annual lottery in which 45 million people are selected at random to not have health insurance for a year. Maybe Congress could help out by donating their healthcare coverage to the needy. If everybody was at equal risk of medical bankruptcy or death by no coverage, I think we’d find a way to extend coverage to everyone rather quickly.

Other good ideas: Anyone who says, “America has the best health care system in the world” will immediately lose all coverage and have one year to write an essay entitled “America Has the Best Health Care System in the World.” I’ll be grading these essays. You can contact me directly for a handout on this assignment.

Idea two, more seriously: Health cooperatives are a promising idea. They might bring on board the blue-dog Democrats, which is vital to any legislation since no Republican save maybe Olympia Snow will ever vote for a reform bill backed by this President. The trick then will be to find a way to get all uninsured Americans into the new National Health Insurance Cooperative by establishing a sliding scale of enrollment fees. Jim DeMint will say this is just socialized medicine in disguise, and he’ll be right, but he might not be able to do anything about it. He’ll have to stay home in South Carolina and drink a deMint Julep.

Really important: Build in real cost controls. Health care costs have to come down or they will grow from being a drag on the economy to being an anchor that pulls us all down. At the current rate of growth, health care premiums are an economic black hole which somewhere between three and twenty years will consume all of our GNP, at which point everyone will work in the health care industry and everyone’s pay will go entirely for health care, a kind of mobius strip of unnecessary procedures using the best equipment money can buy.

A final good idea: Blue Ribbon Panel. Appoint a Blue Ribbon Panel of experts on heath care and tell them to come back in a year with a report and recommendations. Despite the political near-impossibility of reform right now, it’s actually not that hard to come up with a plan that will meet the goals of preserving quality, controlling costs, and covering everybody. Then forget about bipartisanship and ram the plan through Congress. A generation later, they’ll be asking what took us so long.

So there it is. I broke my blog-writer’s block and wrote something about the health care debacle. Now I can get back to the important things in life, like I have to wash my car.

And how sad it is that Teddy Kennedy didn’t live to see it, but I’ll be even sadder if I don’t live to see it.