Courtesy of Ruth Marcus, a supporter of the bill:
A Generous Dose of Caution on Health Reform
The conventions of political pontification do not allow for admissions of uncertainty or ambivalence. Thus, Sunday night's House debate on health care featured bombastic declarations from both sides about the impending disaster (Republicans) or nirvana (Democrats) being ushered in.
In fact, the occasion called for more humility than hyperbole, however unlikely that may have been given the setting. If I were a member of Congress, my floor speech before casting a yes vote would have boiled down to:
Gee, I hope this works.
One of the astonishing aspects of the health-care debate is how little is actually known about the implications of a change this far-reaching. Everyone has a theory, and a model to match, but even some of the most fundamental questions remain the subject of debate.
Ruth Marcus is correct, as far as she goes, and the bulk of her article deals with a myriad of questions about the potential known consequences of various provisions of the bill. There are likely to be even more unknown unanticipated consequences. A giant bill filled with unknowns, with layers and layers of bureaucratization foisted upon one sixth of the economy, is going to have wildly unpredictable results. However, there is one certainty: Costs will not come down with this bill. In any business, when the price to the consumer is reduced, the use of the goods or services increases. Since the bill does not address the actual cost of services, merely the price that is apparent to the consumer (ie, reducing out of pocket expenses to close to zero for those on the new forms of coverage) utilization will go up. This is not rocket science. Since price controls are implicit in the bill (with the expansion of Medicaid and the reduction of financing for Medicare), scarcity will follow. Again, this is not rocket science, but for some reason, when it comes to healthcare, normally intelligent and perceptive people fail to appreciate basic economics. All of this is irrelevant now. The bill has passed.
However, for a person to say that they "hope this works" when so much is at stake, suggests that person is a fool. The system was not broken. It had problems that could have been addressed in an incremental fashion, such that any small modifications of an extremely complex system could have been evaluated and addressed before they created insurmountable problems. The attempt to redesign the entire system is an expression of the greatest hubris.
In ancient Greek tragedies, Hubris usually preceded Nemesis.
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