What's the biggest obstacle to health care reform? Voters!
Yes, the problem is the everyday slobs who spend their afternoons calling senators and congressmen and threatening to withhold their precious votes the next time around if not awarded the following two things immediately: 1) sterling quality health care for all Americans, with access to every doctor and procedure they desire, no matter how superfluous or expensive; 2) absolutely no increase in taxes or deficits to pay for it.
To be responsive, then, to the “simple common sense” of the American people, any proposed health reform must not reduce the revenue of hospitals, lest some neighborhood hospital may have to close; or of doctors, lest some doctors might refuse to see patients; or of the manufacturers of health products, lest they are unable to innovate; or of anyone on the supply side of the health sector, lest they go out of business and have to lay off employees.
At the same time, the “simple common sense” of the American people dictates that any health reform that fails to bend down the growth curve of future health spending — the current jargon for controlling health spending better — is unacceptable, too.
In this sense, we as a nation have become one giant California, which has slowly voted itself into fiscal oblivion. We're doing it one ballot initiative at a time, forever expanding services and spending while refusing any measures to pay for it.
Fortunately, at the federal level we have people called "legislators" whose job it is to save us from our own contradictory impulses. They're the people who will have to decide if we will expand services and raise costs, or cut a bit of both. And of course legislators are terrified of having to make this decision.
The president is no better. He spent much of his recent press conference explaining how nobody will have to sacrifice anything under his "plan," whatever that is, as multiple committees are working on independent versions of the bill.
This is, apparently, how you sell people on an incompletely formed notion -- half of voters won't like because it doesn't expand coverage sufficiently, and the other half won't like because it costs too much.
Somebody may eventually have to point out that you cannot get something for nothing, and that simply "eliminating waste and bureaucracy" cannot fund a multi-trillion-dollar effort. Some legislators may lose their jobs over this.
But the thing that's required to resolve the mess may be even more elusive than a no-cost, high-quality overhaul of our national health care system: courage.