Families and Health Care

Like many American families mine is divided on the efficacy of the President's health care proposal. But in the last few months we have had a great dialogue about the issues involved. We have some experts in the issues in this public policy question. I have a brother who is a physician (cardiologist) and another who is a banker. I have a nephew who sells pharmaceuticals and another who is doing an MBA/MPH at Michigan. I have a daughter who has become something of a public policy wonk. She has become engaged in the debates of the day in a meaningful way.

For the past month or so there have been a series of exchanges among the group. In spite of differences among them, there are some common conclusions.

1) There is a general agreement about what the issues that should be under discussion are.
2) There are a variety of viewpoints. But those viewpoints have been treated with respect.
3) There is a recognition that the insurance companies need to figure out how to cover people, even those with pre-existing conditions.
4) There is some agreement that elimination of the state regulation of health insurance is probably a good idea.
5) While there is disagreement about the cost impact of defensive medicine (I tend to believe the higher numbers others in my family believe the effects are much less important) there is a recognition that the Congress has done nothing to solve this problem.
6) There is a clear understanding that there are tradeoffs in the discussions and that ultimately an expansion of coverage is likely to redistribute utilization in the system - which is likely to lead to rationing in some areas.
7) There is almost universal recognition that the process that the Congress has not been useful or effective in discovering reasonable alternatives.

From my perspective the last is the most important. This group of educated people has had a more substantive discussion about a major national entity that we hire to conduct those kinds of discussions in our behalf.

Over Christmas the banker, who has never been much involved in politics, commented that he thought a good way to proceed on Congress was to change the terms of service to be more like jury duty - members would be chosen on a random basis and would serve for a limited period of time. The recognition of this group that our current institutions are not serving us well should give pause to every elected official.