The Last Health Reform?

I thought this line from last night’s speech was great speechwriting, but not terribly accurate: “I am not the first President to take up this cause, but I am determined to be the last.”

The problem is that at other points during the speech the president was at pains to reassure people that, actually, under his plans very little would change. That’s nice and it’s politically smart. Most people mostly don’t want their health insurance to change very much. But the flipside of that is that while what Obama proposed would ameliorate many problems with the current system and solve a few of them, it would fundamentally leave a lot of the dysfunction of the current system in place. The nature of your health insurance would still be very closely tied to your job, the system would still pay doctors for just doing stuff rather than for curing things, Medicare will still be on a path toward bankruptcy, Medicaid quality would still be extraordinarily hit-or-miss, etc., etc., etc.

This means that whether reform passes or fails, we’re almost certainly going to need to revisit this issue again in 5-10 years in a pretty big way.