I understand why Dick Gephardt might think comprehensive health care reform won't pass. Hell, there are days when I think comprehensive health care reform won't pass. But I don't understand why he'd think that you can pass cost controls on the health care system without also increasing access. The reason comprehensive health reform might not pass is that eventual cost controls scare the hell out of everybody. It can hardly be said enough: Every dollar of waste is also a dollar of profit. If you peel off the liberals and unions and all the other supporters interested in a universal system, then peel off insurers interested in more volume from a universal system, and then peel off the ability of politicians to say they gave X more people health insurance, and you're instead just left with a series of reforms that will reduce the revenues of hospitals, device manufacturers, and drug producers, where exactly do you find the will to overcome their opposition? That said, Igor Volsky and the Wonk Room are too quick to dismiss Gephardt's skepticism. The cost tag on health reform is going to be massive. I've begun to hear numbers like $1.7 trillion over 10 years. The unions and Health Care for America Now don't want to touch the employer tax deduction. No one wants to raise general taxes. There was a huge outcry over giving taxpayers making more than $250,000 28 percent break on itemized deductions rather than a 35 percent indulgence. Employers, of course, are not going to want to increase their contribution to the system. There's a lot of talk these days over the public insurance option. That's become the point of maximum controversy. That's where liberal groups are channeling their energies. But that's a feature of the system. It presupposes the existence of the system. Unless we can actually find sufficient revenues and savings to fund the basic structure, there'll be no public plan because there will be no comprehensive health reform. There are parts of this discussion that are like arguing over engine size and stereo system before you've figured out how to afford a new car.
