Do The People Need to Know the Truth?

Harvard Medical School Dean Jeffrey Flier’s complaints about the health care bill seem oddly vague to me and disconnected from any real knowledge of the provisions of the bill. But at the very end he makes some reasonable points:

So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

I’ll count myself as among those who quietly understands that something more dramatic than what’s in these bills is ultimately needed. And it definitely sounds good to say that we shouldn’t take these first steps without first having a great national deliberation about the bigger changes to come. But I also think that’s a pretty naive way to look at it. The fact of the matter is that the long-term fiscal outlook is dire:

Dealing with this will be hard. If the bill Harry Reid unveiled yesterday is signed into law, it will be easier. It will be easier in part because the bill directly tackles the fiscal problem and reduces the deficit. And it will be easier in part because senators and members of congress who are considering additional ideas to improve the situation will have a recent precedent available of legislative success. If the bill is defeated, tackling the problem gets harder. It doesn’t open the door to a broader national conversation in which citizens lose their bias toward the status quo or interest groups lose their desire to fight for the biggest possible slice of pie.

It would be nice if health reform did more to control costs and reform the delivery system than this bill does. But it does something to control costs and it does something to reform the delivery system. And it improves access for millions of people in need. To hold that latter factor hostage to a pie-in-the-sky belief that if the whole thing goes down in flames more radical change will somehow become possible seems to me to exhibit very strange political judgment.