Clearly the U.S. health-care system is on an unsustainable path. If current
trends continue -- and there is no indication that they won't -- health care
will consume 40 percent of the national economy by 2050. The problem is that
this is a slow and steady decline, producing no crisis. As a result, we seem
incapable of grappling with it seriously.
It's not as if the problems aren't apparent to everyone, whatever
your political persuasion. Costs are rising so fast that every day more than
10,000 Americans lose their insurance coverage. In 1993, 61 percent of small
businesses provided health insurance for their employees. Now only 38 percent
do. Larger firms face greater health-care costs. Yet, Americans do worse on
almost every health measure than most advanced industrial countries, which spend
about half as much on health care per person and have proportionately more
Meanwhile, the political debate is unreal, with conservatives
suggesting that President Obama is endorsing euthanasia and murder boards, and
turning America into Russia. (I guess they haven't noticed that Russia isn't
communist anymore.) The lack of serious discussion is tragic, because the
Democrats' proposals leave much to be desired. They include only a few, vague
measures to rein in costs, and the chief one -- a medical board -- assumes
(improbably) that Congress will cede massive powers to five unelected people who
would have the power to deny people treatments and drugs. The likely scenario is
that expanded coverage and new benefits will be enacted, while the cuts and
curbs will be pushed off to be tackled another day.
Health care is the nation's most serious long-term problem. Social
Security, government pension liabilities, state-government deficits and energy
dependence all pose the same issue. Each of these problems is getting worse by
the day, yet the political system seems unable to take them on and make major
reforms. On these critical issues, America is caught in a downward spiral. It
makes you wish for a crisis.
Monday, August 17, 2009
I don't normally think of Fareed Zakaria as a pessimist. His 'GPS' on CNN is one of the best shows on public affairs today. Yet in his column in the WaPo, he comes across as very pessimistic on America's financial future, given the current trajectories and political paralysis.