Health care overhaul needs new approach

Despite a belated recognition that most Americans care more about lost jobs and the faltering economy than an effort to increase government control over one-sixth of the economy, President Barack Obama has made passage of some sort of health care revision his signature issue.

He wants something he can sign by early next year — with any luck early enough so as not to endanger the re-election prospects of Democratic legislators on shaky electoral ground.

Senate Majority Leader Harry Reid of Nevada has taken the point position on this phase of the effort. He managed to hold his Democrats together long enough to get a vote to open debate on the bill, but after that most bets are off.

Votes on the first of many amendments came last week, and brought the first touch of irony, though it was hardly a surprise.

The only way Senate Democrats can pretend that adding a slew of entitlements and mandates to the already convoluted health care system won’t send deficits through the roof is to include provisions that will cut more than $400 billion from Medicare costs over 10 years.

So Republicans, who routinely claim that Obamacare is the first step on the road to socialized medicine, have decided to defend every penny slated to be spent on Medicare, the closest thing to actual socialized medicine in the current health care “system.”

Sen. John McCain’s amendment to eliminate Medicare cuts was defeated Friday, 58-42.

The political explanation for this total abandonment of principle is simple: Medicare is in place, and most seniors believe they depend on it and may be vulnerable to demagogy — which explains why those of us who would prefer reforms slanted toward more consumer control through market mechanisms rather than more government intrusion hope this bill eventually fails.

Once a “benefit” is in place, it becomes an entitlement almost impossible to displace.

Because of Senate rules, 60 votes will be necessary for final passage, and this early test vote suggests they won’t be easy to come by. Four Democratic senators viewed as “moderate” have concerns about aspects of the current bill, especially the “public option” and whether taxpayer-subsidized insurance plans should cover abortion.

Conversely, some Senate liberals say they won’t vote for a bill that doesn’t include a public option or includes restrictions on abortion funding. They will probably ask for and get concessions whose implications we won’t know about until months after the bill passes, if it passes.

Liberals argue that President Obama ran on a platform of expanding health insurance, and they’re obligated to deliver. But attitudes about expanding government programs have changed since the president was inaugurated. As of Friday, according to Pollster.com, the composite of recent polls on President Obama’s handling of health care, which is a pretty good proxy for attitudes toward the legislation currently under consideration, shows 43.4 percent approving and 49.2 percent disapproving.

Even if sentiments were similarly split in the other direction, such a deep division among Americans argues for abandoning the proposals currently under serious consideration and developing a different, more modest, or even more market-oriented approach.