Stick to necessity in health care reform

To get an idea of the brutal gantlet health care reform will be running in coming weeks, consider this: “Obamacare” has now been officially designated an anti-gun bill by Gun Owners of America.

Say what? Yes, the organization fears the “wellness and prevention” provisions in the bills before Congress might empower the “rabidly anti-gun HHS Secretary Kathleen Sebelius” to punish gun owners with higher premiums.

More broadly, “all this increased spending – and taxes – means that you will have less money to spend on pursuing your real passions: like providing for your family and purchasing guns and ammunition.”

We’ll leave any rebuttals to others. The point is, any comprehensive health care reform bill is going to have lots of moving parts, and any number of interest groups might find threats – real or imagined – in some of them. Enough interest groups get riled up, and it’s all over. It’s far easier to kill a bill than to pass one.

Public support for either the House bill or the version that passed the Senate last weekend is already tenuous. So: the fewer moving parts, the better.

In our view, there are three necessities in health care reform: coverage for the uninsured, quality of care and cost control. Anything that would effectively serve those ends deserves a place in the final package. Anything that chiefly serves a political or ideological agenda ought to be jettisoned, especially if it becomes a liability.

For example, if there is a line that even ambiguously could be construed to affect Second Amendment rights, scratch that line and move on. Fight that battle another day, on its own merits.

Same with the much-argued “public option,” the government-run health plan that originally was supposed to compete with the private market.

This concept could have merit, depending on how it is actually structured, but the three necessities don’t hinge on it. At the moment, all Senate Republicans and as many as three independents and Democrats vow to oppose any bill with the public option. That’s enough to stop the whole show.

What neither the Senate nor the House bills do, however, is seriously address that third and politically hardest necessity: cost control. The Senate makes some gestures in that direction, including a tax on extravagant medical plans (which encourage excessive treatment) and a commission that would propose hard-to-override Medicare reforms. Even those half-measures might not survive attack from the groups they affect.

Without cost control, whatever Congress comes up with could ultimately prove unaffordable – and there goes either high-quality care or broad coverage. Frugality may be a tough provision to carry through the congressional gantlet, but it’s the only guarantee that health reform will work, not merely on the House and Senate floors, but in the real world.