Divying the pain

When campaigning politicians talk about reforming America’s health care system, they’re understandably quiet in identifying who will take the pain that will ultimately be allocated between the three basic groups involved –- patients, providers and payers.

If politicians ever get serious about reform, their big challenge will lie in finding a balance that at least two of these groups find tolerable.  They’re not serious yet.

A new analysis this week by the Tax Policy Center confirms that, giving neither presidential campaign credit for doing anything to cap costs and sensibly concluding that the bottom line here is that insuring more people requires spending more money (Obama’s plan, it concludes spends more money more efficiently to insure many more people).

So the current spate of ads on the topic may seem a bit puzzling.  Here’s how to decode them.

Washington interests are no strangers to spending big bucks to inoculate themselves against changes that appear improbably remote. Postponing reaction until the danger was real would leave them quite bored in the short run and very vulnerable later.

The real danger resembles becoming the odd man out in a game of musical chairs.  In this instance, the isolated outcast that is likely to be nominated as the sacrificial lamb in the health reform debate. 

That fear fuels an escalating effort by the three players – patients, providers and payers – to find a partner who will help shift the cost of change to whoever is left standing alone.

That explains why all involved prefer to spend millions on ads proclaiming their support for the idea of providing health insurance to all Americans rather than actually doing something to make a difference.

The patient-voter group is the target of heavy courtship.

Doctors use American Medical Association dollars to buy ads on buses reminding us that one American in seven lacks insurance.

Insurers sponsor encore performances by Harry and Louise.

Of course, both groups would benefit if all Americans were insured.

Meanwhile patients are not entirely passive. They’re represented by the AARP– administered Divided We Fail campaign, which basically argues that we’re all in this together, so we should begin the conversation with a common set of facts that all believe.

The resulting ads resemble a beauty contest where all competitors pledge to work for world peace because there’s universal support for this high-minded and highly-abstract goal. It isn’t as divisive as proposing a specific peace plan for Darfur or Afghanistan or Georgia.

Insuring more Americans is a worthy, if costly, goal.  But ultimately reform will require a tough conversation how to do things better.  All the ads on the topic are little more than pregame chatter anticipating a debate that’s long overdue and isn’t yet on the horizon.

Jim Jaffe is the health care editor at CenteredPolitics.com, where this piece first ran.