The “Shot Heard ‘Round the World” of Health Reform

It’s ironic to have happened in Massachusetts, but not surprising that an anti-reform Republican defeated a Democrat in the Senate election yesterday. Opinion polls over the past few months suggest that the same result would have occurred almost anywhere. A growing majority of voters across the country are disenchanted with the direction of health reform because politicians on both sides of the aisle have failed to address the general public’s #1 concern—affordability.

Yesterday’s Democratic loss should not be interpreted as a significant Republican victory in the ongoing war to revolutionize health care in the United States. Given the troubled state of the American economy, voters in upcoming elections will be no more impressed with Republicans’ lack of a compelling solution than they are with the expensive (i.e., unaffordable) plan being crafted by Democratic leaders.

One of those leaders hit the nail on the head last week when he noted that Democrats can’t sell a reform plan if Americans can’t buy it. Voters were not buying purely political concessions made to organized labor or Nebraska because they feared (correctly, in my opinion) that health care will cost even more if a bill is rushed to the President’s desk. Opposition to deficit spending is also a powerful message of the vote in Massachusetts, the only state that has effectively implemented the expensive reforms being finalized in Washington.

If yesterday’s outcome is telling politicians that affordability is the #1 issue, then we can only hope that legislators will start looking for ways to lower consumers’ total costs of medical care—a goal very different from reducing the number of uninsured. Leaders in both parties need to refocus reform on supply and demand problems that cause American health care to be unnecessarily expensive and then to promote responsive improvements in the medical marketplace. Some of these serious structural problems, like fee-for-service reimbursement and uncoordinated care, have been addressed in the reform debate. Other important causes of high costs, like counterproductive regulations and organizational inefficiencies, have not gotten the attention they deserve.

I think yesterday’s voters in Massachusetts represent frustrated people all over the country who want our politicians to put top priority on creating a health system that consistently produces acceptable care at reasonable prices. I don’t think reform has been heading in this direction for the past year. Does anyone else share my belief—and, surprisingly, my optimism—that we could build a really good and affordable health care system in the United States if we were to redefine reform accordingly?