Ruth Marcus on HCR Caution

Ruth Marcus offers a sensibly cautious approach to health care reform in The Washington Post (h/t Ezra Klein).

The conventions of political pontification do not allow for admissions of uncertainty or ambivalence. Thus, Sunday night's House debate on health care featured bombastic declarations from both sides about the impending disaster (Republicans) or nirvana (Democrats) being ushered in.

In fact, the occasion called for more humility than hyperbole, however unlikely that may have been given the setting. If I were a member of Congress, my floor speech before casting a yes vote would have boiled down to: Gee, I hope this works. One of the astonishing aspects of the health-care debate is how little is actually known about the implications of a change this far-reaching. Everyone has a theory, and a model to match, but even some of the most fundamental questions remain the subject of debate.

Marcus points out, rightly, that the consequences of a number of elements of HCR are unknown. Most fundamentally, while researchers are confident that having health insurance leads to better health outcomes, there is at least some doubt. Other unknowns include whether or not younger citizens will sign up or choose to pay the penalty, whether expanded coverage will create a shortage of providers, and whether future Congresses will adequately monitor and develop the cost containment elements of the policy.

Marcus concludes:

The legislation is a risk worth taking. Millions of Americans are without insurance, a national scandal that should have been addressed long ago. Rising health-care costs threaten the nation's fiscal security, and the new law holds the promise of beginning to stem the increases.

The status quo is unsustainable. A new study by the Urban Institute shows how, without reform, the numbers of the uninsured will rise, employers will continue to drop coverage and premiums will climb. Still, for those who express cocky certitude about how this is going to turn out, the best prescription is a generous dose of caution.

--Ballard Burgher