David Brooks identifies a key problem with the health care reform legislation milling around Congress: it may not save us much money:
If you read the C.B.O. testimony and talk to enough experts, you come away with a stark conclusion: There are deep structural forces, both in Medicare and the private insurance market, that have driven the explosion in health costs. It is nearly impossible to put together a majority coalition for a bill that challenges those essential structures. Therefore, the leading proposals on Capitol Hill do not directly address the structural problems. They are a collection of worthy but speculative ideas designed to possibly mitigate their effects.
The likely outcome of this yearâ€™s health care push is that we will get a medium-size bill that expands coverage to some groups but does relatively little to control costs. In normal conditions, that would be a legislative achievement.
Thereâ€™s worse things than a medium-size bill that mitigates some negative aspects of our health care structure â€“ except, as Brooks reminds us, President Obama is counting on significant savings in health care to pay for the trillions heâ€™s pumping into stimulus projects.
The theory is this: weâ€™ll be able to pay off the debts weâ€™re generating today if we can reduce our health care costs in the future. But what if we donâ€™t reduce those costs? What if we have to pay back our debts AND still handle increasingly high health-related costs? Thatâ€™s not going to be good for our economy. But itâ€™s the bargain weâ€™re trying to make. And itâ€™s something we need to keep in mind as we debate health care reform.