I finally got around...

...to reading "How American Health Care Killed My Father," David Goldhill's fine article in the Atlantic that everyone is talking about. I agree that it's an excellent piece and one that everyone interested in the health care debate should read carefully. However (and you knew there had to be a "however"), I'm reminded by what Donald Rumsfeld (of all people) said during the Iraq War,"As you know, you go to war with the Army you have." Or to quote Robert Reich, "Devising a [health] plan is easy compared with the politics of getting it enacted."

I believe in this last quote especially. A lot of experts, on the right and the left, have come up with credible health care reform plans. It's really not that hard to devise something that would be an improvement over what we currently have. I could see anything from a single-payer system, like the one in Canada (or Medicare for all), to a strictly free-market system working better than what has evolved in the U. S. The trick, of course, is in getting it passed. And this is one of the reasons I am no longer a libertarian. There's really little value in pondering ideas that can never be brought to fruition. Health care is a great example.

Obama has clearly stated, as have many others, that he would prefer a single-payer system if he could start all over. People like Paul Ryan, Republican from Wisconsin, have put forward more market-based systems that make sense, also. But they are all non-starters, and everyone in Congress knows it. Obama's plan would involve doing away with the private insurance industry, a worthy but unrealistic goal. Any industry that spends more money in Washington than any other is not going anywhere. And anyone who can't see that isn't realistic enough to have a voice in the debate. So the president has wisely decided to build on the current system; trying to take it down is just not possible. (Look at how much trouble he's having now by just tweaking the current system; and make no mistake about it, it's just tweaking.) As for Paul Ryan, on the other hand, he would first need to get a Republican majority in the House and Senate--no small accomplishment. And even then, his colleagues have shown no real appetite to change the status quo. Again, no less a Republican than John McCain once remarked that health care reform could never take place so long as the GOP was owned by the insurance companies.

At the end of the day, politics is still the art of the possible. Or, as Ross Douthat said about that other transformational president, Ronald Reagan, the lesson is in "marrying principle to practicality, tolerating fractiousness within one's own coalition and dealing with the political landscape as it actually exists, rather than as you would prefer it to be." The U. S. is a center-right country, and change only comes glacially. Health care reform has been on the table for a hundred years, since Theodore Roosevelt.

So I'm all for studying health care, and I think Goldhill is on the right track here, but let's get the heart attack victim to the hospital first. Once his situation is stable we can then talk about a sensible diet and exercise regimen.