The Wild Card By BOB HERBERT

September 12, 2009
Op-Ed Columnist
The Wild Card By BOB HERBERT

There’s a lot to appreciate in the latest incarnation of the Democrats’ Sisyphean-like campaign to overhaul the nation’s health care system. In the current environment, matters are growing worse almost by the hour.

Horrendous job losses and an economy that is in shambles are driving up the number of people without health insurance. “Every day,” said President Obama in his speech to Congress this week, “14,000 Americans lose their coverage.”

This is occurring at the same time that the immense baby boomer generation is approaching retirement age, the age when even under the best of circumstances the need for health care steadily rises.

Even those with health insurance frequently find themselves on shaky ground, worried that they will lose it if they lose their jobs or that the coverage will not meet their real-world needs.

So most Americans are prepared to listen when the Democrats try to make the case for changes that would, among other things, prevent insurance companies from denying coverage because of pre-existing conditions, prevent them from engaging in the perverse practice of canceling policies when the policyholder gets ill, put an end to arbitrary caps on annual or lifetime coverage and limit what policyholders could be charged for deductibles and out-of-pocket expenses.

When you factor in the explosive costs of health care, which are making American businesses less competitive and threatening to bankrupt the government, the case for reform would seem to be a slam dunk.

But there’s a wild card out there undermining the chances for real reform, and it’s not the crazies who have been disrupting health care forums or the disrespectful space cadet legislators like the South Carolina Congressman Joe (“You lie!”) Wilson. It’s the ordinary working men and women of America who are struggling with the worst economic downturn they have ever seen and who are worried that the big new plans that the Democrats have in store may not be in their best interests — and may not be affordable.

Many of those folks already have health insurance, and many voted for Barack Obama. But they’re scared to death now as the economy continues to hemorrhage jobs and the budget deficits unfolding before their eyes are being counted in the trillions.

To get meaningful health care reform this time around, the Democrats will have to get that constituency on board. They haven’t yet.

For one thing, the various proposals are not at all clear to the general public and the average citizen is clueless as to how any of them would be paid for. To say that people are skeptical is the grossest understatement.

When the administration talks about getting hundreds of billions of dollars in savings from Medicare to help finance health care reform, it sends a shudder not just through Medicare recipients (who like their coverage just fine and don’t want anyone tampering with it), but also through younger individuals concerned about elderly relatives on Medicare.

The president said in his speech that the savings would come from eliminating “hundreds of billions of dollars in waste and fraud” and the elimination of some unwarranted subsidies. But to the finely tuned ear of the general public, that’s exactly what politicians always say: We’re going to get rid of waste and fraud.

The administration would contend that this time will be different. One can understand why some will remain unconvinced.

The president also said, as he estimated the cost of his proposal at $900 billion over 10 years, that he “will not sign a plan that adds one dime to our deficits — either now or in the future.”

I’m sure he means it. But I have not spoken to anyone, either on Capitol Hill or elsewhere, who believes that is doable. Now it may be that the public should not be so worried about the deficits. They had to be jacked up to get the country through this terrible economic crisis. And health care reform — real reform — is essential if long-term deficits are to be brought under control.

But people are worried about it. And just saying that health care reform will not add to the deficits is not enough to allay those fears.

What’s missing from all the talk about reform is how the runaway costs of health care, and all the dire consequences associated with them, can be reined in without a strong public insurance option and other big-time cost-saving initiatives.

If the government requires everyone — or nearly everyone — to have health insurance, the insurance companies and the pharmaceutical industry will reap a bonanza. What the Democrats still have to make clear to ordinary working men and women is how this latest incarnation of health care reform will be cost effective and broadly beneficial to them and to their government.