Health care reform: First, do no harm

Here we go again.

Fifteen years after Bill Clinton’s health care reforms sank in a sea of bickering Democratic lawmakers, President Barack Obama is making another run at the monumental problems of the American health care system.

Obama has some advantages. Unlike Clinton, he was elected by a majority vote, and he’s got lots of political capital to spend. Also, conditions are riper.

Last time around, the wind in the sails of health care reform came from a recession that had millions of Americans fearful of losing their jobs – and their insurance. Public interest dropped once the economy revived.

This time around, the job losses are worse, public anxiety is higher and the country seems to have reached broad agreement that all Americans ought to have health coverage.

Now as then, though, the devil’s in the details. Clinton dumped more than 1,000 pages worth of details on Congress in a massive reform bill; critics were already picking it apart before it saw the light of day.

Obama is doing the opposite: He’s merely sending eight “principles” to Congress – such as cost controls, a choice of plans and a goal of universal coverage – and asking it to come up with details.

Since every Democratic committee baron and her lobbyist cousin will now be fighting for control of this behemoth, we’ll propose a few principles of our own:

 • Make everyone pay. During the presidential campaign, Obama scored cheap points against Hillary Clinton by denouncing her plan to require all individuals to carry insurance.

But Clinton knows this issue better than Obama. Short of a Canadian-style single-payer plan, reform can’t work without an individual mandate – subsidized, in the case of the poor. Too many “free-riders” – especially the young and invulnerable – choose to remain uninsured when they could afford at least low-cost “catastrophic” coverage. When they get hurt or sick, the rest of us pick up the bill.

 • Preserve the doctor-patient relationship. Government-heavy medical systems – the U.S. military’s, for example – commonly give patients the doctors who happen to be available, not physicians or nurse-practitioners who’ve been tracking their health for years. People need real medical homes.

 • First, do no harm.

Hyperinflation of medical costs is the reason so many Americans and businesses don’t buy or provide insurance. Obama and many others have plausible ideas for forcing efficiencies and economies on the system. But when trillions of dollars are up for grabs, powerful forces start grabbing.

Democrats have been part of the problem. Medicare is one of their (deservedly) prized accomplishments. But Medicare has done as much as anything to feed the beast with easy money, and far too little has been done over the years to rein in its costs. Congress has never shown any stomach for cutting into middle-class entitlements, and “reform” promises new entitlements – potentially lax and budget-busting despite Obama’s best intentions.

Universal access to quality care cannot happen if costs aren’t controlled. Cost and access are the same problem. And costs are least likely to be controlled when a generous Congress pretends to offer patients something for nothing.